September 2008 Blog Article Revisited
The following is a re-post of an article I wrote ten years ago. It is just as true and relevant today. I have now been in practice for 50 years, have recently started my fifth practice, this one in Mount Dora, Florida. I still love what I do and practice in the same way I did ten years ago. Simple, referral based, no insurance, no advertising, no fancy, expensive equipment. Just exceptional care people are willing to pay for and are happy to tell their friends and family about.
Keep it Simple While Always Striving for Excellence
During my forty years as a Chiropractor I have always practiced in a resort area, the Hamptons and Shelter Island, NY and now in the Bahamas, which has given me a unique perspective. Practicing in a resort area I have always seen patients from all over the U.S. as well as from other parts of the world. This means a large number of my patients have had experience with Chiropractors “back home,” and often these patients have confided their dissatisfaction with the quality of care they receive at home. Of course it is always flattering for me to hear comments like “Can I take you home with me?” But the frequency with which I have heard such things has made me wonder where our profession is going wrong?
What is wrong? What is missing? It seems to me that what is going wrong in Chiropractic is a lot of the same thing that is going wrong with the Medical profession. Healthcare has lost its proper perspective and is more focused on the “bottom line,” meaning dollars, than it is on taking proper care of the patient.
It’s Quality not Quantity That Counts!
Quality Care Requires Good Technique, not Fancy Equipment
The measure of a chiropractor is not the size of his office or the number of professional toys he has acquired. Good technique skillfully practiced by a caring doctor is what makes an effective and successful Chiropractor.
Instruments are tools that should be used to enhance the practice of skilled, effective Chiropractic technique. Fancy equipment is no substitute for knowledge, skill and experience. A million dollars worth of equipment will not turn an ineffective Chiropractor into a good one. Without an effective technique, all the fancy, expensive equipment in the world will not make you a good Chiropractor.
Don’t go into hock trying to buy all the latest greatest equipment. Your debt load and overhead expenses will keep you awake at night, give you nightmares, ulcers and “angina.” Your big fancy office may impress your peers, but only quality care makes the patients come back.
Patients want a Chiropractor who makes them feel better – as quickly and comfortably as possible, without costing them an arm and a leg. No one wants to feel that he or she is just a billing opportunity, or that you need them to keep coming back as often as possible for as long as possible just so you can pay for your expensive toys. This just causes resentment.
In the beginning patients may be impressed by your layout and your sales pitch. They might keep coming for a while, hoping all this expensive equipment will make them well. But if they are not happy with the quality of their care, if they have to spend too much of their precious time in your waiting room only to be hustled and jostled from one fancy automated table to another spending most of their appointment either alone with a machine or with an assistant, spending only 3 to 6 minutes with their doctor, resentment builds and they begin to wonder why they are wasting their time and money. No one wants to feel they are treated like a number with dollar signs attached.
They stop coming. They don’t send their friends and relatives. And then you have to go further into hock with expensive advertising and “special offers” in an effort to constantly attract new patients. More nightmares, less sleep, longer hours running faster and faster on that treadmill trying to get ahead. Not the career of your dreams.
A Caring Attitude – “Heartfelt Healthcare”
We need to put the “care” back in healthcare. Technique and skill are essential, but not sufficient. The best, most effective technique in the world, practiced by a skilled but uncaring technician won’t keep patients coming back.
While it may be true that some people will accept cold, impersonal or even harsh treatment in their search for someone who can make them well, they usually have to be pretty desperate to keep coming back for that. Perhaps, if you are so skilled at fixing people that you can take the really difficult cases, the suffering, desperate souls who have been “everywhere” searching for someone or something to relieve their pain, and if they can walk into your office feeling horrible and leave feeling well, then you may not have to worry about your interpersonal skills. Like the oncologist with a good track record, patients may keep coming even if you are cold and uncaring.
But most people want to feel they are important as individual human beings, that they are “seen, heard, and understood” as individuals with unique and personal issues. They want their doctor to look at them, listen to them and make them feel that they matter.
A Patient focused practice
In this time of very competitive healthcare, where so many doctors advertise “no out of pocket expenses” to draw patients in, any doctor who wants to be competitive yet operate a cash practice, must provide a level of care that is head and shoulders above the care a patient can get down the street for “no out of pocket.” Why should they take money out of their jeans for you if they can get the same care without making a hole in their wallet?
However, people will pay you for exceptional care and a satisfying overall experience in which their needs (physical, mental and emotional) are met. For people to willingly pay you with their hard earned dollars, they must receive both real and perceived value. Patients deserve and should expect the best care you can provide. And not just in the “courtship” phase of the doctor/patient relationship, but over the long haul, throughout continuing care.
Too often doctors talk a good game in the initial phase of care, but then once they feel they have the patients “hooked” their care becomes more of a perfunctory, “slam, bam, thank you ma’am, see you Wednesday and Friday ad infinitum” affair, a sure prescription for dissatisfaction and resentment. The fact is, most patients have an excellent “BS detector,” and know when they are being taken to the cleaners. They rightfully resent it, and word spreads. Then everyone loses.
The bottom line is, every office visit should be taken as seriously as the first, and the focus of the doctor’s attention should be on the patient, his condition and his concerns.
Your patients really don’t want to spend their visit with you listening to you talk about your Mercedes, boat or airplane, your new house or your latest vacation. They could care less and really don’t want to hear you brag about your success or how you spend the money they give you. They are paying you to give them your full attention and want you to listen to their concerns. Too often the Success Gurus teach that we must show off our financial success to patients as evidence that we are good at what we do. But what the patient wants and the most convincing proof that you are a good doctor is for you to take really good care of them, always doing the absolute best you.
To be good doctors and truly successful, we need to remain focused and committed at all times to excellence in patient care. We need to be true to our own principles as well as to the values and philosophy of our profession. If we work each day and approach each patient with a true spirit of service and a healing, success will follow naturally.
Just keep your focus on the patients and their needs and your needs will be met. If you take good care of them – they will come.
Personal Reflections
During my forty years as a chiropractor I have always practiced in a resort area, the Hamptons and Shelter Island in New York and now in the Bahamas, which has given me a unique perspective. Practicing in a resort area I have always seen patients from all over the U.S. as well as from other parts of the world. This means a large number of my patients have had experience with Chiropractors “back home,” and often these patients have confided their dissatisfaction with the quality of care they receive at home. Of course it is always flattering for me to hear comments like “Can I take you home with me?” But the frequency with which I have heard such things has made me wonder where our profession is going wrong?
What is wrong? What is missing? It seems to me that what is going wrong in Chiropractic is a lot of the same thing that is going wrong with the Medical profession. Healthcare has lost its proper perspective and is more focused on the “bottom line,” meaning dollars, than it is on taking proper care of the patient.
So, do I practice what I preach?
I strive each day to do just that: Keep it simple. Keep it real. Always strive for excellence. Maintain a spirit of service and healing. And it is working.
My practice and my life just keep getting better and better.
But I had to learn from my own past mistakes. For me, this is TAKE TWO.
Tired of complications
After some 30 years of practicing in the Hamptons, working my butt off to constantly “grow the practice” to cover a huge and ever growing overhead, keep up with the competition and, as taught in so many of the practice building seminars, to put on a show for the world, show off and “look prosperous,” I got tired. I was whipped, physically and emotionally drained. I had a successful practice. But what did that leave me for the living of life? When did I have the time to enjoy the fruits of my labors?
I was sick and tired of working to support a big office and staff. And my body just wouldn’t let me do it anymore. I sold that practice. Actually, I was unable to work and was on disability for four years.
Those years gave me a lot of time to re-think my life and work. I had allowed myself to get caught up in the proverbial “rat race.” I was forced to take a good, long look at what that had done to me. What had it cost me? What had I gained from it? I had a lot of “things:” a house in Shelter Island and one in Palm Desert, California, a 44 foot Trawler Motor Yacht, nice cars, etc, etc. But it had cost me my health. And a lot more.
And after four years I realized I was really failing at retirement. I missed my work. For me, being a Chiropractor had always been more than just a “profession,” and more than just a way to make a buck. It was a calling. It was a passion. I loved taking care of people. I missed taking care of people.
I wanted to go back to work, but this time, I wanted to keep it simple. I wanted to provide really good health care to people and to maintain my own joy in doing it. I decided to focus on providing personal, quality care, to keep it simple and make it fun.
I had always strived to do this. And I believe my patients have always received very good care – they must have thought so, too, since they kept coming back, and many came from long distances and far off places to receive the care I gave them. But over time, as the practice grew and I was seeing over a hundred patients a day, the amount of time spent with each, was, by necessity, diminished, and I could not possibly give each patient the attention I could in a smaller practice.
I did not want to repeat that. And I did not want to have to stress my own body by having to work to support a large, fancy office and staff.
I wanted a small, personal, cash practice. And that is what I have achieved. I have a small, simple office. My wife and I work together. I have no other staff. We don’t take insurance assignment and we don’t process insurance paperwork. We don’t take credit cards, either. But no one complains.
I use a homemade flat bench adjusting table, a set of SOT blocks and two hand held electronic instruments which I love: the ArthroStim and VibraCussor. That’s it. Simple.
My wife and I enjoy working together and we love our patients. We have a personal relationship with each and every person who comes into the office. Each patient gets our undivided attention while he or she is with us. Often whole families come into the adjusting room together. More and more of our patients think of me as their primary care doctor. They consult with me first, before going to their MD. The high level of trust, respect and affection we get from the patients is very rewarding.
We are happy; our patients are happy and feel well cared for. They send their friends and family members.
Ours is a “warm and fuzzy” kind of practice, where we treat our patients like one big family. Don’t get me wrong, I am definitely results oriented, and I get great results. In fact, better results than ever before! My patients get better and they get better fast. I don’t try to keep anyone coming in more often or longer than he needs to. I often smile to myself because so many of my patients ask to come in more often than I am recommending. They like to come to our office. They always feel better when they leave. They don’t mind paying because they know they get their money’s worth. It win/win all around.
I run a completely referral-based practice and have not done any advertising. I am not even listed in the phone book. In fact, for the first year I didn’t even have a sign outside. But the patients keep coming. I am seeing as many patients as I want to and have a waiting list each week.
I am not over-worked or over-stressed. I finally have the practice of my dreams – simple, patient oriented, effective, loving, joyful and profitable.
So, almost 40 years after I began in practice, what is my philosophy and my rules for success in practice?
Keep it simple. Strive for Excellence. Be honest. Be real. Be true to yourself and Serve your patients.
Post Script:
This article was written ten years ago. I have now been in practice for 50 years and I still love it. And I still practice the same way.
I now split my time between the quaint village of Mount Dora in Lake County, Florida and my beloved Abaco, Bahamas.
Two years ago we started a new practice in Mount Dora. It is a small but comfortable office. Kiana and I work together just as we did in the Bahamas. I am the only doctor, I still use just a flat bench table, my SOT blocks, the ArthroStim® and VibraCussor® instruments. I have added a GRT® Lite and am doing a lot of work based on Quantum Neurology® by Dr. George Gonzalez. It is a cash practice. No insurance. But lots of patient focused exceptional care that produces exceptional results and lots of referrals.
In just two years, with no advertising we have built a steady, thriving part-time post retirement practice. I work only by appointment, schedule 3 days a week, am always booked in advance and my work just keeps getting more and more enjoyable and personally rewarding.
We like Mount Dora. It is in a beautiful area and is a charming, peaceful, friendly and safe little town. We are still surrounded by water – lakes this time. And we are only an hour from the ocean if we want beach and salt water.
We still have our boats in the Bahamas, which is only an hour and a half by plane. We go back as often as we can. So now we have the best of both worlds.
