The Kinetic Chain of Lateral Joints

(Originally published The American Chiropractor December 2018)

The lateral joints of the body are the most mobile, complex and subject to injury. They form a deceptively interrelated chain of movement and function in which malfunction of one component can and often does affect the others.

The kinetic chain of lateral joints consists of the temporal mandibular joint, shoulder, sacroiliac, hip, knee, ankle and foot joints. Integral in the kinetic chain are the muscle, tendon and joint mechanoceptors. They supply the continuous sensory input to the brain regarding the status, function and coordination of the individual components of the chain. Proprioceptive dysfunction caused by injury, postural stress, joint dysfunction and muscle splinting must be reset to normal if any lasting spinal or extremity correction is to be achieved.

The functional relationship of lateral joints was recognized decades ago by SOT founder Dr. Major DeJarnette.  He said, “Lateral joints affect lateral joints and central joints affect central joints.” The validity of this concept becomes apparent the more you work with the kinetic chain and observe how the correction of foot, ankle and knee positively affects the hips, sacroiliacs and shoulders.

The interrelationship of the sacroiliacs and shoulders is frequently observed during the pre and post arm fossa tests which are monitored during SOT Category II blocking for sacroiliac slippage and separation. One of my most recent cases is a perfect illustration of this interrelationship.

A 36 year old female consulted me primarily for multiple lumbar disc herniations for which she was told she would require surgery. My examination denied the discs as being the pain generating mechanisms causing her lower back, buttock, anterior pelvic and hip pain.  I did find a very active Category II sacroiliac slippage and separation, symphysis pubis subluxation, posterior and anterior femur head dysfunction, and right 5L-S1 facet imbrication. In addition to her lower back symptoms, she informed me that she had an unstable right shoulder that was very susceptible to dislocation and was scheduled for surgery in a few weeks to “tighten it up.”

When I performed her initial right arm fossa test as part of the Category II testing protocol, I found her right shoulder and arm to be very weak and painful.  When I rechecked the same arm fossa test only a few moments later after the blocking was completed the arm and shoulder tested perfectly strong and without pain, much to the patient’s amazement.

While I have no doubt that the shoulder needs repair, its connection to the sacroiliac subluxation is irrefutable.  I am confident that the Category II correction that I did will help assure a more successful outcome for this patient’s shoulder repair surgery. The strengthening and reduction of shoulder pain after Category II corrections of the sacroiliac is a common occurrence for me and other SOT practitioners.

Correction of TMJ dysfunction often has a positive effect on problems involving the shoulder girdle. In some cases the entire kinetic chain from the foot, ankle, knee and sacroiliac to the TMJ can be involved in shoulder problems. This possibility should always be considered since shoulder problems are among the most difficult and persistent issues we confront.  Malfunction among the numerous components of the kinetic chain of lateral joints is an illustration of what experienced chiropractors know:  If we only investigate and treat the site of pain we are likely to miss as much as 85% of the cause of our patients’ problems.

The temporal mandibular joint (TMJ) is the superior most component of the lateral kinetic chain.

The TMJ influences more neurological function than any other joint. It is richly endowed with a variety of mechanoceptors which provide the most sensitive and intricate of all proprioceptive information to the brain.

The action of the TMJ maintains the opening of the eustacean tube to equalize the internal pressure of the middle ear with the outer environment. Failure of this mechanism causes otitis media, the painful inflammation with fluid and pressure that builds up in the middle ear when the eustacean tube is closed due to TMJ dysfunction.

A lesser known but equally important function of the TMJ is to activate the micro movement of the sutural joint system of the skull.  Failure of the balanced movement of the cranial sutures leads to elevated intracranial pressure and associated cranial nerve dysfunction, migraine and cluster headaches and vertigo.

The TMJ interacts functionally with the cervical spine and can become a complicating factor that must be corrected to permit complete and lasting cervical corrections.

A recent case of an 80 year old female who was referred to me by her medical doctor is a good example of TMJ involvement affecting the upper cervical spine.  When she was 12 years old she had a right side head and upper cervical injury that caused a severe concussion.  In spite of a lifetime of chiropractic care, the persistent pain in her right occipital/atlanto/axial area was at best only partially and temporarily relieved.  This painful condition persisted and sabotaged her health and wellbeing for 68 years. The extreme chronicity of her condition was apparent in the thickening of the cervical musculature, hypertrophy of the trapezius and congestion of the suboccipital tissues and line fibers. These splinting and guarding mechanisms caused severely limited cervical and thoracic movement and resistance to correction.

The Quantum Neurology® Rehabilitation protocols for the trigeminal, vegas and spinal accessory nerves allowed immediate improvement of cervical range of motion and relaxation of the para-cervical musculature, the trapezius and SCM. This in turn allowed effective TMJ correction which, in conjunction with an instrument adjustment of atlas, gave an immediate and lasting level of relief that she had never before experienced.

I am certain that without the cranial nerve and TMJ correction, my upper cervical adjustment alone would not have been effective, just as it had not been for the other chiropractors who had tried to help this woman over the past seven decades.

The traditional admonition of “find the subluxation, fix it and leave it alone” applies in uncomplicated cases. But in very chronic and complex cases, as in the example above, we must entertain the possibility of other neurological and structural components as being contributors to the movement disorders and pain that many patients experience.

The objective of all chiropractic correction is the re-establishment of the alignment of the six spinal motor units (as described in the Pettibon Spinal Model) and the restoration of full freedom of motion.  This is unlikely to happen without correction of any faults in the alignment and motion of the entire kinetic chain.

Any part of the lateral kinetic chain can influence and affect any or all of the other parts of the chain. To achieve complete body balance, coordination and comfortable freedom of movement, the entire kinetic chain of lateral joints must be integrated and aligned.

The reciprocal arm and leg movement seen in the walking gait of a normal, healthy person illustrates interrelated and coordinated upper and lower extremity movement. Conversely, when we observe someone who exhibits absent, limited or unequal reciprocal arm and leg movement, it strongly suggests neurological as well as structural inhibition and imbalance.

I have thus far discussed the upper lateral chain consisting of the TMJ and shoulder girdle.

The seven joints of the pelvis, the two 5L-S1 facets, sacroiliacs, ileo-femoral joints and the symphysis pubis, form the junction of the appendicular and the axial skeleton.

I have written extensively about the importance of balancing the pelvis in my articles The Pelvic Imperative and two part article The Comprehensive Examination and Correction of the Pelvis, previously published in The American Chiropractor.

The kinetic chain of the lateral joints of lower extremities includes the lateral joints of the pelvis, the sacroiliacs and ileo femoral joints, as well as the knees, ankles and feet.

Any alteration in alignment or motion at any point in the kinetic chain will necessitate compensatory changes in alignment and motion of the joints above that point.

If we do not address faults of the foot, ankle and knee, our correction is likely to be incomplete and compromised.

The foot and ankle form an amazing complex, a Rubric’s Cube like arrangement of 26 bones and 36 joints.  These must fit properly together to function and move well.  The foot has three arches, the lateral, medial and transverse, which are critical to the flexibility and shock absorption of the feet.

The four bones that make up the knee are key components of the same kinetic chain. The extreme leverage exerted by the long bones of the leg, the femur, tibia and fibula, apply tremendous force to the hip, knee and ankle joints and can magnify the affects of even a small misalignment in any of the involved joints.

The kinetic chain of the lower extremity is first evaluated generally and then in detail. First observe the lateral relationship of the joints of the hip, knee and ankle. They should be aligned vertically. Next observe the A – P alignment of the upper leg to the pelvis and the upper leg to the lower leg.  Is the patient bow-legged or knock kneed?  Do the feet flare out or in?  Do the feet pronate or supinate?

Like the alignment of the spine, the alignment of the bones and joints of the lower extremities are of utmost importance to the overall structural correction.  Because of the length of the upper and lower leg bones, even slight deviations of the proximal or distal ends are magnified at the opposite end.  This causes excess friction, heat and inflammation.  The pizeo and pyro electric charges that are generated are caused by a separation of electrical charges at the surface of the joints, ultimately causing the deposition of calcium and destruction of the articular cartilage. This is the leading cause of the osteoarthritis we see in our patients.

On A – P pelvic views, if there is DJD of the hip joint it is almost always on the anatomically or chronically functional long leg side. This is because the hip joint on the long leg side experiences more pressure and wear and tear with each step than does the short leg.

Correction of foot, ankle and knee misalignments and fixations is extremely important. To accomplish this I use both manual and instrument techniques which are very difficult to describe in writing. I teach these in my classes on Integrated Advanced Chiropractic Techniques and will soon have videos available.

The feet are the “footings” of the skeletal structure. When the foot is properly mobilized and the subtalar joint adjusted, I often find the residual effects of old ankle sprains are corrected as well.

After correcting imbalances in the feet and ankles, the knees must be addressed. There are potentially two dimensions involved in knee misalignments, posterior translations and rotations.  Posterior translations of the tibia and fibula can be adjusted manually or with instruments. Rotations of the tibia are best corrected using the ArthroStim instrument. Correction is achieved when the anterior tubercle of the tibia is positioned directly below the center of the patella.

Above the knee in the kinetic chain is the ileo femoral joint or femur head. Dysfunction of the femur head involves the posterior and anterior joint mechanoceptors, which may be misfiring on one or both sides of one or both hips.  For proper afferentation to the motor cortex via the spinal sensory pathways we must reset the mechanoceptors on both anterior and posterior sides of the femur heads. The best way I know to achieve this is via the anterior and posterior femur head corrections which are part of the Gonzalez Quantum Neurology® Rehabilitation techniques.

Next we move up to the sacroiliacs, which are most efficiently corrected by SOT Category II blocking.

Once the foot, knee, ankle and hips (femur heads and sacroiliacs) are properly adjusted we have successfully realigned the kinetic chain of the lower extremities.

The restoration of normal freedom of motion and coordination of all of the joints of the lateral kinetic chain as well as the restoration of spinal alignment should be the goal of chiropractic corrective care. The joint systems of the axial and appendicular skeleton are functionally interdependent and must be addressed if whole body correction is to be achieved.

 

 

 

 

 

 

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The October Koch Protocols Advanced Chiropractic Technique Seminar Was Fantastic!

Kiana and I recently finished another great Koch Protocols Advanced Chiropractic Technique Seminar.  This one was the best yet!

Each time we do this, it seems to get better and better.  And we enjoy them so much. We put a lot into these seminars, and we get a lot out of them. They are truly a labor of love.

I am so proud of the quality of the doctors we are attracting.  All are already experienced, successful practitioners who want to continue to improve their skills for even better results while protecting their bodies from the injuries that are inevitable when practicing traditional, full contact techniques. The Koch Protocols help them do just that.

Because we keep the seminar small and personal, we all get a chance to know one another.  Kiana and I always feel we make new friends, and I believe the doctors attending feel the same way.

We spent 3 ½ days together. It was almost 40 hours of a “See It, Feel It, Do It,” hands-on experience. There was lots of learning, lots of practice, lots of camaraderie, food and fun. The doctors were all so involved in what we were doing, they didn’t even want to take the typical lunch breaks. So, Kiana made sure there were always platters of various kinds of food so that we could forage and not waste time going out.

When it was over we were all sorry to say goodbye. That is how it should be.

We have scheduled the next course for January 25-27, 2019.  We hope you will join us.

Dr. Bill Koch

352-729-2678

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Where is Your Joy? Time to Renew Your Passion for Your Chiropractic Practice

Yes, It is Time to Renew Your Passion for Your Profession!

First Posted October 2010 as Where Is Your Joy?

What is a day in your office like for you?  Is going to the office work, or fun? Is it just the thing you do to pay your bills and support your family?  Is it what you thought it would be when you were in Chiropractic school? If not, why not?

How much of your time and energy are consumed by administrative chores like paperwork or dealing with and trying to motivate staff?  Are you stressed by a high office overhead?  Do you feel like a salesman trying to sell your patients on extensive treatment programs?   Do you have to beat the bush for new patients?  How much time and energy do you spend trying to educate people about Chiropractic?  Are you having fun?

There are only three good reasons to practice chiropractic:

Serve People – Have Fun – Make Money

If your focus is on serving people then having fun and making money are inevitable.   It really is as simple as that.  The key lies in giving the patient what they want.  They all want the same thing — to feel better and be free of pain as fast and inexpensively as possible.  

Give them what they want and your patients will love you, trust you and spread the word.

When your patients see that you have no agenda other than helping them, they will trust you.  As trust and confidence in you build, they will come to think of you not just as their Chiropractor, but also as a friend and confidant.  You may become the doctor they consult first for all manner of health-related issues.  Many will check with you about the recommendations of other physicians.  They will do this because they respect your opinion and have confidence in your judgment. And because they know you care.

When a coming to see you is something that patients look forward to as opposed to a time-consuming, expensive chore to be endured, you will be on your way to a practice with minimal stress and a lot of joy.

Joy is contagious. When patients perceive your joy in helping them, they will be happy and they will want to share the joy.  They will want to tell their family and friends about it.  Your practice will grow. Your stress will diminish. Your days will be fun. Your work will be your joy. That is your success.

How do you find your joy? Do what you love, do it well, have fun doing it, follow your passion, focus on your patients.  Find your joy and the money will follow.

How do I find my joy? I find joy from being the best chiropractor that I can be.  Do I think that I am the best chiropractor in the world?    Hell no!  But I will die trying.

The truth is there is no one who can be called “The Best.” We can only each strive to be the best we can be.

However, I am privileged to know some really great chiropractors.  They are not only great technicians; they are people with a great depth of knowledge, experience, and above all wisdom.  These are the doctors I would go to if I had a serious health challenge.  They are the doctors who not only have holistic practices, but holistic minds.  They see big pictures, not microcosms.

This year I agreed to do a series of articles for The American Chiropractor magazine. Each article called for me to interview a Chiropractic technique innovator and teacher.  It proved to be one of the best things to happen to me in a long time.  It introduced me to some of our profession’s rising superstars.

Since the year 2000 I had been Lay’n Low in Abaco surfing, sailing and diving, semi-retired in paradise.  Problem is — paradise is an intellectual wasteland.

I really needed some intellectual stimulation.  Learning about the profession’s latest innovations directly from the people who did the research and development, proved to be just what I wanted.

Then I took it a step further.  Instead of just writing about the doctor’s techniques, I took it upon myself to study and become proficient in them, remaining true to the pledge I made to myself and my patients 43 years ago: To always give my patients the benefit of the best state of the art care chiropractic has to offer.

Today, at age 65, practicing in the out islands of the Bahamas, I am more excited and enthusiastic than ever about my work and the constantly evolving art and science of Chiropractic with its expanding role in healthcare.

I am semi-retired and living in “paradise,” but if you really want to know the truth, it often seems I have a lot more fun in the office taking care of people than when I am out “playing.”  After 43 years in practice, I still really love what I do.

I would like to share with you how I keep my referral-only cash practice fun, exciting, joyful, rewarding and constantly growing.

Your mission, if you choose to accept it . . . is to cultivate your healing consciousness, a dedication to excellence, and never say or think the words “that’s good enough.”

Remember these words from an old airline advertisement: “We earn our wings every day.”

This is a Great Time to Be a Chiropractor

We live in very interesting, challenging times. Some DCs are frightened and negative about the state of health care in the U.S.  I am not.  I think it is a blessing.  It is an opportunity to help more people than ever before.

The public is justifiably more and more suspicious and distrustful of the medical paradigm. They are eagerly embracing Chiropractic’s natural, holistic, non-drug approach to health care.

Forty-three years ago, when I began in practice, Chiropractic was on the fringes of respectability.  My generation of DCs, building on the work of our forefathers, brought the profession out of the shadows and into the mainstream.  As a result, today you can practice anywhere.

Dedication to Excellence

We owe it to our patients and ourselves to be the best that we can be.  We should demand no less from ourselves.  It is what our patients have the right to expect from us. Dr. Burl Pettibon said it like this; “When you know that you know what you are supposed to know, then, and only then, will you will have confidence in yourself and others will have confidence in you.”

Dr. Sid Williams often said in his Dynamic Essentials Seminars; “You must perfect yourself in the science and art of Chiropractic until you feel that you can master of any situation that you might confront.”  That means having the professional judgment and integrity to always do the right thing for your patient. It also means remembering what Dirty Harry said: “A man has to know his limitations.”

I have known chiropractors who would dive in naively where angels would fear tread, but there are far more who refer patients out to the MDs the minute they felt challenged by a case.  This is because they did not have the experience, confidence or tools they needed.   If they had, they most likely would have been able to help the patient instead of throwing them to the wolves.

My Mission

My mission is to help as many chiropractors as I can to elevate their skills and confidence so they can better serve their patients and have well deserved sense of pride in their own professional expertise.

This pride must be based in fact, not hype or self-aggrandizement.  When you know that you know what you are supposed to know, you are powerful.

Joy and fulfillment is found in serving people well, relieving pain, restoring health and the appreciation that is expressed by grateful patients.  Beyond that, performing with excellence is its own reward.

As I said, I’ve been practicing Chiropractic for 43 years.  I’ve had my ups and downs, successes and failures.  There are lessons to be learned in both.  Experience is the ultimate teacher.  43 years gives a guy a lot of accumulated experience. You find out the hard way what works and what doesn’t.

The important thing is to constantly strive for excellence.  Never fall into the trap of complacency that says “good enough is good enough.”

For me now, after so many years in practice, it is important for me to share what I have learned through all that experience, and in the process, shorten the learning curve and smooth the road for others. What a waste it would be to accumulate a lifetime of knowledge and experience but not share it with those who can use it to help others.

My ChiroPractice Made Perfect blog and seminars are the means I have chosen to begin sharing the experience, expertise and insights that I’ve accumulated.

In my hands-on technique seminars, you will see many advanced techniques in action in a real-life setting. You will see how a variety of techniques are efficiently integrated for maximum results.  You will see that the best chiropractic technologies are not only compatible but can complement and enhance one another.  I believe we must have many specialized weapons in our arsenal that we can apply to a variety of situations and needs.  We need to be able to customize our approach to the ever-changing needs of our patients.

Our patients are ever changing.  If you really think about it, you will never see the same patient twice.  Just like the river you put your foot in today is different than the same river will be when you put your foot in it tomorrow.

Any technique that does not allow us to accommodate to the changing needs of the patient is doomed to failure.

We as chiropractors come to the table with our own strengths and weaknesses. Just as each patient is unique, so is each doctor. Each of us must find the techniques that we can use most effectively.  That is one of the biggest challenges for all of us, but especially for young, less experienced chiropractors.

One of the most important things I have to offer is my expertise in many fine, effective chiropractic technologies and specialized procedures.

I have been the beneficiary of the knowledge and experience shared with me by my fantastic teachers and mentors, people who were generous and patient, giving freely and joyously to help me be the best chiropractor I could be.

It is a beautiful progression.  Think about it.  Thanks to the work and generosity of others, they have, through me, been able to help untold thousands of people. Now it is my turn to share what I have learned with you.  It is a passing of the torch.

Not that I am ready to hang up my guns, not by a long shot.  I just feel that the time is right and the need is great for what I have to offer the current generation of chiropractors.

The most successful chiropractors I have known truly enjoy their practices.  I am convinced that taking joy in what you do is a prerequisite for success.  Coincidentally it is also a recipe for health and longevity.  I have personally known many chiropractors who have practiced well into their eighties and even a few into their nineties.  I can tell you for sure, that they weren’t doing it for the money.  It is my personal goal to be one of them.

 

If you want to improve your skills, attract more patients and have more fun and joy in your practice, consider joining me for one of my Koch Protocols Seminars.

The next one is at the end of October at my office in Mount Dora.

We have one spot left — just waiting for you.

 

 

 

 

 

 

 

 

 

 

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One Spot Left in the October 26 Seminar

Kiana and I are so excited about the upcoming seminar.  We limit the class to six doctors and we now have one spot left.  We have put together a great group of experienced doctors from all over the country. These doctors are all interested in increasing their skills, upping their game, getting better results with techniques that spare their bodies, thus extending their careers. These doctors want to be a Two-Percenter — one of the top two percent in the profession.  See my article Are You a Two-Percenter?

Please join us on October 26 for 4 days of the most fun you will have ever had at a chiropractic seminar.  You will learn so well from my See It — Feel It — Do It teaching technique that you will be able to apply what you have learned on your first day back in the office.

We hope you will join us!

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Testimonials for Koch Advanced Chiropractic Technique Seminars

What some doctors are saying about Koch Advanced Technique Seminars

 

Dr. Koch and Kiana have put together something really special with this chiropractic program.  Dr. Koch has found a way to integrate 50 years of clinical experience into a systems-based approach that speeds up clinical diagnosis, treatment and getting to the heart of patients’ issues.  Although the information is densely packed, Dr. Koch has found a way to deliver the material in a user friendly and accessible way that is beneficial for anyone from the newbie starting out into practice to the seasoned veteran.  As a doctor who has studied many different techniques over the years, it was refreshing to see how seamlessly Dr. Koch has blended together several different chiropractic approaches into an integrated and non-dogmatic format.  I think that there are very few chiropractors who have this unique ability in our profession.  His compassion for his patients and passion for his profession come through every step of the way.  Thank you, Dr. Koch, for raising the bar in chiropractic!

– Dr. Jeremy Ste. Marie –

 

After 30 years of manual adjusting, my body was saying it was time to take it easy and start working smarter, not harder. Dr. Koch was the perfect answer. He has taken some of the key technique elements from some the top masters of the profession and blended it into an evidenced-based scientific protocol that is easy to follow and use on your patients right away.

Much focus is placed on the relationship between the pelvis and cervical spine, which in my experience is key.

Being in practice over 50 years, he is a treasure trove of stories. From personally knowing the developers of our chiropractic techniques, to his sailing stories and practicing in the islands, there is never a dull moment.

His wife Kiana is a knowledgeable CA who works right by his side and is also a wonderful host. I was impressed that in our study group were very experienced DC’s from all over the country who love chiropractic and are still open and striving to learning.

Well done Dr. Koch and Kiana.

Dr. Russ Ficara

 

To my friends Dr. Bill and Kiana

Thank you for the great seminar in Mount Dora last week.  Your system of evaluation and correction is very precise and effective without being forceful and uncomfortable for the patients. You are a technique master yourself and I feel very blessed to have learned from one of the best in our profession.

Thanks again for sharing your wisdom and your hospitality.  We all enjoyed it very much and look forward to seeing you again!

Yours in Chiropractic,

– Dr. Pete Haugen –

 

Dr. Koch and Kiana are amazing people. I found the clinical material to be very useful, relevant, and was able to use a lot of the techniques in practice the following week. Dr. Koch is a wealth of knowledge and has a lot to offer. Thank you both for a great seminar and I look forward to the next one!

– Dr. Samuel Kranz –

 

Koch Advanced Technique Seminars — simple to learn, yet profoundly effective.   I’ve only taken the first seminar and the results are simply outstanding.  In 4 visits, I am having patients with long term hip issues being reduced substantially to where they are able to get out and live life again. 8 out of 10 patients I am able to have them go from an 8/10 in pain to 0-2/10.  In follow-ups with these patients, I am finding they are for the most part maintaining for a month or two following their last visit.  Personally, I find this remarkable, because it is correcting something that in the past might last for a few weeks before they come back with the same issue again. Having patients tell me they can walk up stairs again with little to no pain or go on long car rides with little to no pain is amazing!

I’ve been to countless technique seminars and have used all sorts of equipment to help patients get better. Yet I find the effectiveness of this technique, using only SOT blocks, the VibraCussor and ArthroStim, is outstanding.  All soon to be docs, new docs and even seasoned docs need to experience this technique.  It has the lowest equipment cost investment for any doc and the results are amazing. Where else can you have all the equipment you need for about $3,500! Very little overhead needed and the patients do refer their friends! It is an amazing system.

Dr. Bill does a phenomenal job teaching, and it is a hands-on seminar from the beginning!  He is a mastermind and has learned from almost all of the past and current virtuosos.

If you have limited funds and are looking for the best bang for your buck, your practice and your patients, then this is the seminar! It is worth every red cent.

– Dr. Bryon Blackwell –

 

 

Dear Dr. Koch,

 

Thanks for an awesome seminar! I’ve been to a lot of seminars but yours was one of the more personal and practical I’ve ever been to!  You are a great teacher!  I would highly recommend your seminar to anyone who is looking to get better outcomes with their patients, no matter how long they have been in practice! It was such a pleasure meeting you and your wife Kiana. I wish you all the best as you are a treasure of a doctor and a great asset to our profession. Thanks so much for your hospitality and friendly nature, you were a pleasure to meet and spend time with.

 

God Bless

Dr. Vince Paolicelli

 

 

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October Koch Advanced Technique Seminar rapidly approaching

Wow!  I cannot believe how long it has been since I was here.  My last blog was right after our March Seminar — which was a smash hit.

And since then it has been so incredibly busy, I somehow neglected my blog.

Since my last post I have been doing a lot of writing.  Kiana and I created a seminar manual that is almost 300 pages — so I am dividing it into two separate books for the October Seminar.  One is a very detailed, step by step, illustrated Technique Manual that will be a lasting reference.

In June we had another seminar and it was fantastic.

Each one is better than the last.  We are getting a great mix of people from all over the country and even from Canada. Everyone has had a fun learning experience and we are all creating a great professional network and lasting friendships.

I could not be happier.

Our next seminar is October 26 through 29.

We have one spot left.  Why don’t  you join us in Mount Dora?  It will be unlike any other course you have done or will ever do again.  And you will never regret it.

We are limiting it to 6 doctors (families invited).  It is a 4 day intensive, personalized, interactive, hands-on learning experience like no other. You will learn an amazing amount of information and technique you can apply as you get home.  And you will have a great time doing it!

Think about joining us.

Call 352-729-2678 today.

About the October 26 Koch Protocols for Integrated Advanced Chiropractic Technique Seminar

This is a truly unique program that provides a memorable “YES!” experience. We have worked to create a personal, fun, interesting, informative and immediately useful class – the kind that Dr. Koch would have loved to have taken himself years ago.

See It – Feel It – Do It!

During the four-day seminar scheduled for October 26, 27, 28, 29 we plan to meet for 7 to 8 hours each day and you will learn an enormous amount of useful information that you can put into practice as soon as you get back.  This is not just a lecture course, but also a hands-on workshop.

Dr. Koch will teach how he does his First Visit consultation, examination, and treatment, including the way he uses muscle testing to determine specific areas of weakness or imbalance, and then retesting post treatment to ascertain for the doctor and demonstrate to the patient the positive results gained through his treatment protocols. Dr. Koch is all about evidence-based diagnosis and treatment and will teach his protocols in a way that will allow you to begin using them right away.

Each doctor will get to See It — Feel It — and Do It — so they can experience and learn how to perform simple protocols utilizing the hand-held instruments and SOT blocks as well as some gentle soft tissue techniques to get fantastic results quickly and comfortably for both the patient and the doctor.

Dr. Koch will teach the way he first balances the pelvis, addressing all 7 pelvic joints, then how he corrects issues in the thoracic and cervical spine.  He will also demonstrate the way he works on the extremities, including the shoulders, elbows knees and feet.

Each doctor attending will be evaluated and treated by Dr. Koch and so will get to feel what it is like for the patient who experiences these protocols.  Then everyone will have a chance to practice the technique on each other. In past seminars some doctors brought their spouses or children and they got adjusted, too.  It is really helpful to have a variety of cases and real issues to see how well these protocols really work. So, we welcome family members who would like to join us for all or part of the course.

Also, each doctor attending will receive a seminar manual — the last one had grown to 320 pages!  So, we will be dividing it into a couple of different books.  One of them is a step by step illustrated technique manual, which we can send in advance once you are registered.  It can serve to better prepare you to get the most out of the seminar and as a refresher/reference afterward.

The other is a text that is a collection of articles about the Koch philosophy of practice, some technical articles and his ideas on how to have a Koch style cash practice – a ChiroPractice Made Perfect.   And everyone who attends will get a signed copy of Dr. Koch’s book “Conversations with Chiropractic Technique Masters.”

The first 3 days will contain most of the “meat” of the course, all the basics of what you need to know.  The 4th day, could be optional if any doctor cannot take that Monday out of office.  But if you can do it, that day has proven to be extremely valuable as it will help tie together and “set” everything you have learned.

Day 4 will be spent practicing the techniques everyone learned during the first three days. And everyone will have an opportunity to ask their questions and talk about personal issues. Dr. Koch will also discuss how you can have a referral-based cash practice with less stress, more time and energy to enjoy your practice, your family and private life — and to take better care of your own health — all with a better bottom line.

Imagine what it would be like to eliminate much of the paperwork that burdens you as well as the hassles and liabilities of insurance, the endless waiting and uncertainty about when and how much you will get paid — or even if you will get paid at all.

Wouldn’t it be nice not to have to live in fear and dread of an insurance audit — and the possibility of having to pay them back? We have heard so many horror stories in this regard. It makes us shudder. So, we will talk about how to have a successful referral-based cash practice.

Dr. Koch also has a fantastic exercise program he likes to teach. It only takes about an hour to demonstrate and let everyone try it out. It is a Functional Fitness program involving spinal range of motion and spinal molding or rehab exercises, as well as his special multi-plane exercises that protect the spine while strengthening the core and upper body.  These exercises are all performed supine using light hand weights and foam rolls. They work amazingly well without the risk of injury.

They are deceptively easy, but can be as challenging as you need them to be. When he demonstrates, he makes them look really easy, and they are. But with a few modifications they can be made challenging, even for those much younger who work out regularly.  Yet most of them can be easily performed by almost anyone. His patients love them.  And patients love doctors who give them some self help options.

Dr. Koch has been doing these exercises for decades.  They are largely responsible for his being able to practice and live an active life at age 73 after 50 years as a chiropractor.  At the Florida Chiropractic Association National Convention last weekend, people kept remarking about how fit Dr. Koch was, saying, “You must work out. What do you do?”  These are the only exercises he does regularly.

That is the basic description of the seminar.  Please feel free to phone Dr. Koch or myself with any questions.

Or just to chat about your practice and your issues/interests.  We like to get to know every doctor attending so that we may personalize the class as much as possible.

If you are interested in learning more there are many articles I can send you.  But I do not want to overwhelm you now.  You may read more at the Technique Institute or http://kochseminars.com/    You may also check him out on LinkedIn and Facebook. Look forward to speaking with you again soon.

Best regards,

Kiana and Dr. Bill

352-729-2678   home and office

 

 

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March Koch Protocols Seminar was Fantastic!

Last Tuesday Kiana and I wrapped up our five day Koch Protocols Seminar on Integrated Advanced Chiropractic Techniques. It was great.  We made new friends. Everyone had a good time and learned a lot.

The objective of my teaching is to provide young and older chiropractors alike with the kind of program I would have been excited to attend. This was exactly that.  We were a bit sad when it was over, but were energized and inspired to make the next one even better!

My teaching method is simple:  See It – Feel It – Do It. This has proven to be a very effective and enjoyable way to teach technique intensive procedures and protocols.  The proof is in the excitement and enthusiasm of not only the doctors in attendance but also of their wives.

Kiana and I were amazed that the wives stayed for the entire 5 day 40 hour program.  We had thought that the wives would just stop in for an occasional visit and would spend most of their time touring our beautiful towns and villages, relaxing or shopping.  Instead they stayed with the program and, like the doctors, were examined and treated.  This was an added bonus because each provided a unique sampling of conditions to be addressed.

Another evidence of the enthusiasm of all those attending was that they didn’t even want to take a lunch break.  They instead elected to stay and just snack on the organic fruits, nuts, cheese and crackers, hummus, guacamole, salsa, organic blue corn chips and other goodies that Kiana provided. The owner of our local hair salon even surprised us a scrumptious, homemade carrot cake that was a real hit. We did everything we could to make those five days enjoyable.

Some of the doctors had been in practice for more than 35 years and were feeling the effects on their bodies.  They were hoping to learn techniques that would be physically easier on them, while getting better results for happier patients.   Some also want to transition from insurance to cash practice. Which is what the Koch Protocols are are all about.The Koch Protocols for Integrated Advanced Chiropractic Techniques seminar excels at teaching both.

My protocols eliminate the repetitive motion stress and strain on the doctors’ bodies, allowing them to extend their careers rather than feeling forced to quit for the sake of their own health.  My protocols consist of a number of advanced techniques, most of which can be done with the ArthroStim and VibraCussor electronic instruments. The important thing is that my examination and correction procedures wow the patients with results they can see and feel immediately.  The Koch Protocols get quick results that patients recognize and are happy to pay for out of pocket.  They also are eager to refer their family and friends.

All of my patients come to me as referrals from happy patients and other professionals.  They know in advance I do not take insurance or process insurance forms. They come to me knowing that I am “different.”  That is why they come to me.  Because I am different. They are tired of the “same old, same old.”

Most every new patient I get has made the rounds of other DCs, MDs, and PTs.  Many have had failed back surgeries. They come frustrated with their previous care and many have despaired of ever finding real help.  Thankfully, I help the vast majority of them and it is very rewarding to be able to do that.

I want the doctors I instruct to experience the joy of true exceptionalism and the rewards it brings, while extending their careers without hurting themselves. That’s a win for both doctor and patient.

Kiana and I are already looking forward to our next Koch Protocols Seminar.  It will be four days – June 8 through 11.  We would love to have you join us for a unique practice experience.

To learn more and to register please call Kiana at 352-729-2678.  Or email outislanddc@drwilliamhkoch.com

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How Do You Want to Practice in These Interesting and Challenging Times?

I have been reading some of the articles I wrote 8 years ago on my thoughts about the right way to practice. They apply today as much as they did then and I want to share them with you.

How do you want to practice?

Blog post: Interesting Times 1/21/2010

When I watch the news on TV or listen to the radio, I am reminded of the old Chinese curse: “May you live in interesting times.”   Chiropractors and all other health care professionals are anxiously following the debate over “health care reform.”  We know that change is coming and that it will have a profound effect on our practice and the way we do business.

We will soon be faced with two choices:  Practice in accordance with the new health care reform and in effect become a government employee.  Or, declare your independence and practice privately.

The choice will be difficult for some, but easy for others.   Most people practicing today have depended heavily on one form or another of third party payment to provide them with a patient base.  For some it is a personal injury, or workman’s compensation practice.  For others it is as a participating provider in an HMO or PPO.   Doctors who have been accustomed to a primarily third party pay practice might not find the idea of working under a universal health care program to be offensive.  On the other hand, those of us who have had private practices will find the idea of government bureaucrats dictating how we run our practices and care for our patients to be unthinkable, and therefore the choice is easy.

The third group is made up of the doctors who do not like the prospect of practicing under a government administrated health care program, but question how they could have a viable private practice.

If you are in this third group, you are the one I want to talk to.

Having had a private practice for 42 years, this is something I know a little bit about.  My first 30 years of practice was in The Hamptons and now in the remote out islands of The Bahamas.  Two very different places, but the principles still apply.  I have often said that “unless your patients think enough of your services to write a check or pull cash out of their jeans, you don’t have the practice you think you have.”

It is really very simple.  People will pay for exceptional care.  They will not pay for the same generic care they can get for no out of pocket expense down the street or across town.

The way to build a private, cash practice in these difficult and challenging times is through what I call “THE PATIENT FOCUSED PRACTICE.”

“THE PATIENT FOCUSED PRACTICE” is the term I use to describe a philosophy of practice, the one I have found that best serves my patients and provides me with the most satisfying practice experience.

‘THE PATIENT FOCUSED PRACTICE’ is not a marketing term.  It is a philosophy of practice and an attitude that says the needs of the patient comes first.  There is no agenda other than to serve the needs of the patient.  No agenda to educate the patient about the chiropractic story, philosophy or the stages of subluxation degeneration.  There is no campaign to recruit new patients.  No lecture about the importance of lifetime care.  The patient never feels that he or she is the target of a sales pitch.

What the patient does experience is the feeling that they have been very well cared for.  That they have been carefully listened to and they know that we understand their condition, concerns and worries.  Whether new to chiropractic or an experienced chiropractic patient, they are invariably impressed by their examination and the obvious care that goes into my analysis and the details of their adjustment.  Most importantly, they leave our office knowing that something good has been done for them.  They have seen objective evidence of improvement and in the vast majority of cases, improvement in their symptoms.  They leave the office with confidence that they have come to the right doctor, one who can and will do all that is necessary to help them, as quickly and economically as possible.

You might find it curious that I am telling you not to do what all practice builders have been telling their clients to do for the last 40 years.  Am I just being contrarian?  Or maybe I have a better way.

The simple truth is that I learned long ago what worked for me and what didn’t.   It took me many years to realize that it was not my business to sell chiropractic.  It was far more important to sell myself.  I found that the best way to sell myself was not by telling people about me and what I do.  It was by showing them results.  I found that it wasn’t necessary that my patient believe in chiropractic as long as they believed in me and that I am the guy who can help them.  My job is to make sure that I am that guy and that I do everything possible to give them the results that they come to me for.

I attended the two most popular practice building seminars on a regular basis for years.  I got out of my comfort zone as recommended.  I did weekly patient lectures in my office.  I pressured my patients to attend.  I required all new patients to sit alone in my consultation room to watch chiropractic orientation videos on their first visit, then another video before their report of findings, and yet another prior to an interim report of

Findings, the point at which continued care or maintenance was to be recommended.  My patients resisted the pressure to attend lectures.  Others walked out on the videos never to return.

I followed these and other programs to the letter as recommended by the “experts.” I paid “big bucks” for a one year series of 6 seminars and private consultations with one of the “super star” management consultants who was one of the regular featured speakers at the big Texas based seminar program.’

I spent a day in his office, attended two of his seminars and had two private consultations.   I found his recommendations to be offensive.  There was no way I could subject my patients to his strong arm tactics.  There is no way that if I were the patient that I would put up with a doctor who practiced what he preached.   He blew his credibility with me when he told me that if I were spending more than 2 minutes with each patient, I was wasting time.  He even recommended that my assistant actually time my office visits with a stopwatch. He went on to warn me against asking my patients how they are doing, reasoning that they would waste my time telling me.

Is this kind of practice building advice obsolete?  Unfortunately, it isn’t.  Many management gurus are still preaching the same old messages to young chiropractors today.

A visit to the website of one of the self-proclaimed top dogs in chiropractic, gave these clues about his practice philosophy:

  • I never do anything that I can have one of my girls do.
  • I do not talk to my patients except for the 2-3 minutes that my hands are on them.
  • I have weekly staff motivational meetings to formulate new patient recruitment strategies, and what the y should do to improve patient compliance with his long term care recommendations.

The same doctor, who spends only 2-3 minutes with his patients, spends an extraordinary amount of time, money and effort advertising, doing mall shows and other promotions to drum up business.

I would suggest that if he spent more time on seeing to the care, needs and concerns of his patients, he wouldn’t have to be out beating the bush and having motivational meetings.

This approach to chiropractic practice building and patient management is still with us.  I do not think that it serves the best interests of the patient, doctor or profession.

No one can tell me that time spent taking excellent care of patients is ever wasted.  It pays dividends in the form of great results and patient satisfaction.  When your patients feel they are well cared for, their perception of the value of your service skyrockets.  That equals high level professional satisfaction and justified pride in a job well done on your part. It is the patient’s satisfaction and the confidence which you inspire that will make your patients happy and proud to refer their friends and family.  You won’t have to ask for their referrals, they will ask you if you could possibly fit in another new patient.

That is the way your practice can and should be.

 

IF you want to learn more about what I think is ChiroPractice Made Perfect, come to one of my Koch Seminars.  I would love to see you there.

Koch Protocols Seminar One March 23-25   and Seminar Two March 26-27

Other dates in June.

 

 

 

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There Has Never Been a Better Time to Be a Chiropractor

I have been reading some of my older blog posts and have been pleased and a bit amazed at how true and relevant they remain today.  So I have decided to share some of them with you.  Below is one I wrote in October 2007 — one of my very first blog posts.  That was before I even had this website.  It still reflects my core beliefs.  And I still think this is a great time to be a chiropractor.

There Has Never Been a Better Time to Be a Chiropractor                                    Original Blog Post October 2007, Abaco, Bahamas

There is nothing more powerful than an idea whose time has come.  Chiropractic is the idea and now is it’s time.

I can say this with the perspective of 40+ years of experience in the profession.  I entered Palmer in October 1963, and began practice in November 1967.  I have had the pleasure and great satisfaction of seeing chiropractic grow and develop into the highly respected profession it is, a force to be reckoned with in the healing arts.

It is very sobering to think of being in practice for 40 years. [Now 50] That means that I am not a kid anymore, even though I still feel like one. This has been a time of reflection and introspection.  It is also a time for looking forward to the future with excitement and great expectations.

Sometimes it seems like the blink of an eye, other times it seems like forever.  I vividly remember the early years:  The fight for licensure in New York, the satisfaction of watching my practice grow from one patient to thousands,  striving to grow as a person and a professional.  It’s been a great ride.  It has been a lot of things, but never boring.

Experience is a great teacher.  It is something you can’t buy, you have to live it.  Thankfully it is something that can be shared with those who are smart enough to learn from the successes and failures of others.

If you are a chiropractic student, I can tell you that you have made a wise choice, provided you are in it for the right reasons.  If you are already in practice or about to enter practice, the world is your oyster.   You need only decide what kind of doctor you want to be and what kind of practice you want to have.

If your idea of a perfect practice is to specialize in personal injury, workman’s compensation or to be a provider for a PPO or HMO, or if you want to engage in a DC/MD practice, then read no further.  What I have to say is probably not for you.

However, if you want a personal, private, cash practice, with low overhead and high net income, and a high level of personal and professional satisfaction, then you will probably find what I have to say interesting and chock full of the information you want.

My objective is to share with my readers the kind of information that I wanted as a senior student and later as a new doctor trying to find my niche in the profession and my community.

Transitional times are always difficult.  There are many unanswered questions, questions one would logically expect to be answered in chiropractic school, but somehow slipped between the cracks, remaining question marks in the mind.

These unanswered questions, and the insecurities and confusion they cause have given birth to an industry and profession within the profession: the Practice Management Consultant.

For a hefty fee you can sign up to learn how to build a practice, draw patients and get paid.  There are many “formulas” — some good, some bad, some ugly.

 

There is a saying in the used car business: “there’s a butt for every seat.”  Somehow that seems to apply here.  Every consultant can showcase a few individuals who have great success under their guidance.  What they don’t talk about are those who are not comfortable with their methods and marketing tactics.  Instead of rapid practice growth, they experience inner conflict, confusion, and disappointment.  Not unlike the patient who is looking for The Doctor who has the “Magic Bullet” that will fix their all their problems.

 

No one has all the answers, and I certainly wouldn’t claim that I do.  What I do have is a lot of experience.  I have built three successful practices.  My success has inspired more than a dozen young people to become chiropractors, and I have mentored many recent graduates, helping them to be effective practitioners, building and enjoying their own practices.

What is the point of accruing a lifetime of experience, if it isn’t shared with those who can benefit from it?  When I share mine with you, then I not only help you, but the patients you serve as well.

There are so many factors involved in the practice of chiropractic.  Chiropractic is a thinking man’s/woman’s profession.  There is no “cook book” formula.  There is no such thing as a “general adjustment” or “routine adjustment.”  Slam, bam, thank you Ma’am — see you Monday, Wednesday and Friday—for as long as you or your insurance company will pay — is not a recipe for success.

Neither is buying all the expensive, fancy, automated and computerized “toys” of the trade.  They may add to your impressive “décor” and make your practice look successful. But they will rarely add much to your ability to provide exceptional patient care.  They most definitely add to your debt, your overhead and your stress levels as you try to figure out how to pay for it all.

We must integrate our science, philosophy and art.  It is of no value to talk philosophy, if we don’t deliver the results.  It is up to each of us to provide our patient with the best that our profession has to offer.  Individually we must develop our chiropractic artistic abilities, without which our knowledge is simply academic.

I want to share with you what has worked well for me, including the subtle nuances and specialty procedures that can make the difference between success and failure in difficult cases, and help you to get results so fast that you and your patients will be amazed.

Nothing succeeds like success.  Fast results, achieved economically, are your best practice builder.  Coincidentally, that is what put chiropractic on the map in the first place.  Unfortunately it is no longer the norm.  Too many chiropractors are seeing their patients too often for too long.  As a result, reputation for fast, economical results that the profession once enjoyed has been lost.

Fast results will cultivate a high level of enthusiasm among your patients and encourage referrals.  Conversely patients are reluctant to refer their friends and family to a hard sell DC who recommends and tries to commit every patient to a zillion office visits. Patients are reluctant to return to someone they see as just trying to sell them something to make as much money as possible.  And they don’t refer their friends and relatives.

A recent new patient in my office described his experience with another Chiropractor like this:  “I thought the guy was trying to sell me a time share.”

All too frequently I hear people express reluctance and skepticism about going to a chiropractor, saying something like “I don’t want to start with a chiropractor because, once you start, they keep you coming forever.”

To succeed personally and as a profession, this negative image has got to be reversed.  It is the responsibility of each of us to see that we are part of the solution.

The medical model of healthcare is in big trouble.  People are thinking for themselves and questioning what was once considered dogma.  They are doing their own research on the internet. The unquestioning compliance with every edict of the MD is over.  They are starting to question what their doctors prescribe.

Why do you think TV is so full of advertisements for prescription drugs, surgical procedures and even orthopedic appliances, all of them suggesting that the patient tell their doctor what they want?  Each advertisement contains at least 6 “see your doctor” and “ask your doctor” and “follow your doctor’s instructions” messages.  When the patients are being told by the pharmaceutical companies to tell their doctors what they want and need, something is surely wrong.

And worse than that, the MDs feel pressed to comply with patient requests, whether or not they think it is the right thing to do, simply for fear that if they don’t give the patient what he wants, she will go to another doctor who will.

Medical doctors are having a bad time with their public image and credibility, and rightfully so. Yes, there has never been a better time to be a chiropractor.

Chiropractors who are smart enough to return to the traditional values that made chiropractic successful in the first place will enjoy the ultimate professional and personal rewards.

I am semi-retired in The Bahamas.  I have a beautiful wife, a great house, a 50 foot sailing yacht and 26 foot powerboat – with the time and money to enjoy them.  I am enjoying life and practice more than ever.

Getting here wasn’t exactly easy. Nothing worthwhile ever is, but I am confident that by sharing my experiences, insights, and lessons learned with you, I can help shorten your learning curve and help you to have the kind of practice and life you want in a lot less time than it took me to do it.

I want to help you enjoy the Joy of Professionalism that is part of what has kept me motivated all these years.

I will help you develop the competitive edge which will distinguish you from the mediocre strip mall chiropractor.  You know, the guy with the big yellow pages ad.  He takes every insurance plan that will let him in.  He does workman’s comp and PI.  He offers “no out of the pocket expense.” He will shine your boots, buy you pizza and give you a chance to win a trip to Hawaii compliments of his office, if you will just be his patient.

Your competitive edge will not come from hyperbole, come-ons and gimmicks. It will come naturally from developing a dedication to clinical excellence and with love and genuine caring for your patients. It is what I call “The Patient Focused Practice.” That means delivering on the promise of our philosophy, producing the results the patient comes to you for and doing it quickly and economically.

What kind of chiropractor do you want to be?  What kind of practice do you want to have?   How do you plan to achieve your personal, perfect practice?

I want to help you. That is why I have created my ChiroPractice Made Perfect blog and seminars.  I want to share with you the knowledge, people skills, and technical expertise accumulated and developed in a long professional career.

The educational process necessary to earn your Doctor of Chiropractic Degree and the all that is required prove your knowledge of the basic sciences and clinical sciences are by nature, left brain activity.

Then suddenly, upon completion of the academic part of chiropractic study you suddenly have to turn on your right brain — the part of your brain 8 years of higher education has kept in relative dormancy.  You have to get creative about practice and you have to hone your intuitive skills.

If you want to be successful in patient care and to develop the effective doctor/patient relationships which will cultivate a good practice, you need to be predominantly right brained while applying your left brained skills.  In other words you need to arrive at the right balance of right and left cerebral integration.

This is not easy for many of us.  It is a delicate but necessary balance to achieve. It hinges on your communicative skills.  What I call “Patient Focused Communication.”

How do you speak with authority without using extravagant language which to the patient might sound like you are lecturing at a scientific symposium?  Way over their heads. At the same time you don’t want to overly simplify or dumb it down. This does not always come naturally. It takes thought and practice.

I use “Patient Focused Communication” tailored to each patient. It is important to be able to communicate with others on their level.

Effective communication is necessary in every doctor /patient encounter and is vital to your success.  It is a skill that has taken me years to acquire, and I can help you develop your personal style which will help you better relate to your patients and them to you.

No matter how eloquent we think we are, when the patient doesn’t hear what we are trying to tell them, we have a failed communication.

_____

Come Learn From Me

These days I spend most of my time in the quaint village of Mount Dora in central Florida, not far from Orlando and just over an hour from either coast.  It is a lovely community.  After 50 years in practice I still love what I do and have no intention of giving it up.  Two years ago I started a part time post-retirement practice here, which has grown organically and keeps me as busy as I want to be.

I do a lot of writing for the profession. You can find my articles in The American Chiropractor magazine or at theamericanchiropractor.com

My desire to share the knowledge and experience I have gained in over 50 years in the profession is strong. So I am now focusing a lot of my energy on seminar/workshops for chiropractors.  I call them the Koch Protocols — Integrated Advanced Chiropractic Technique.

I hope you will join me for one.  The next on is March 23-25 for part one and 26-27 for part two (optional).  We are limiting attendance to 8 doctors for this hands on workshop. We still have one or two spots left.

You can read more here https://drwilliamhkoch.com/koch-seminars or at http://kochseminars.com/ 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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A Patient Focused Practice

Lead By Example

If we are to have credibility as physicians and teachers of a healthy lifestyle, we must lead by example.  We must be seen as people who practice what we preach.

If you meet one of your patients in the supermarket, you can be sure that they will look at what you have in your shopping cart.  It had better not be full of Kool-Aide, Coke, Twinkies, potato chips and Hamburger Helper. If you are overweight, smoke and are known to drink too much, you might as well forget giving health related advice.

Most Chiropractors enjoy a healthful lifestyle.   Each of us should be our own best advertisement.  We should share with our patients the things that we do personally to stay strong and healthy.  The more personal we make it the more it will mean to them and the more likely they will be to follow our advice. It is good if we are known to practice what we preach. We should be known as doctors who always strive to give his or her patients the best care possible keeping up with the latest innovations and research in order to better serve the patient.

Patient Education — Teach How to Live a Healthy Lifestyle

Most people know that there are things that they should be doing to improve their health but, the reality is that they are usually too busy with professional and family obligations to find the time to research and figure out what it is they should be doing.   If they do start reading they quickly find there is an overwhelming amount of information out there, much of it contradictory, which leads to confusion and frustration.

As part of a holistic, patient focused practice, we teach good nutrition and how to supplement with vitamins and other supplements. Patients like it when we serve as a source of information and can clear up some of their confusion.  They appreciate it when we filter the information for them and translate the technical jargon into simple terms they can understand and use to improve their health.

That kind of “patient education” is useful. There is no need to try to dazzle them with technical dissertations on the subluxation complex and spinal degeneration.  Most patients, even if they can comprehend all that, really don’t care or need to know. Rather than waste their time and mine trying to impress them, I teach my patients things they can use to help themselves.

And, again, the best way to teach is to lead by example.  Don’t forget to practice what you preach.

Stress control or stress management is another important thing we should teach our patients. We all know that stress plays a prominent role in almost every case that we see. When we help our patients address the stress in their lives they feel well cared for and cared about.

Patients who feel well cared for want to come back. They refer their friends and family. What better practice building tool could there be?

Take the time — it will pay off in the long run

I know that many DCs think that they do not have time for these additional services.  All they want to do is find the subluxation fix it and leave it alone.   I too subscribed to that line of thinking for much my career which has now spanned 50  years.  During many of those years I personally saw 100+ patients per day.

I liked knowing that I could attract a high volume of patients, and I can honestly say that I did take good care of them — to a point.  What was lacking was the human factor.  I gave them good adjustments, and certainly that is the most important thing we do, but I have come to believe that there is more to being a chiropractor.

The subluxation is a major cause of dis-ease, but it is sometimes a secondary or even tertiary cause.   When what should be good adjustments repeatedly fail to hold, we must expand our thinking. The answer seldom lies in adjusting the patient more often and over a longer period of time.   That is why many chiropractic patients get frustrated with their care and complain that, “I feel better for a little while but it goes right back out.”  This is a major cause of patients giving up on chiropractic.

The answer will always lie in re-analysis.  Is a change of our adjusting formula, listing or category necessary?  Or do we need to look beyond? Perhaps we have to expand our vision of what constitutes the real underlying cause. Perhaps we need to look outside the box.

Finding the cause of the cause – Sometimes it requires a little detective work.

Certainly the subluxation causes health problems, but often we have to ask: “What is the cause of repetitive re-subluxation?”   This often takes some thought, observation and investigation.  A good example of this was a recent case of a woman who does the bookkeeping and accounting for her family’s business.  She came to me complaining of a typical cervical/brachial radiculopathy.

When after a few visits, we had made little if any progress, I knew that I had to look further.  I questioned her about her work space.  What she described did not sound good, so I visited her office to see it for myself.

What I found was an ergonomic disaster.  Her computer keyboard was positioned too high.  Her mouse was in an awkward position and her monitor was far off to her right side causing her to spend many hours each day with her head and neck in 45 degrees of right rotation.

I called her husband up to her office and explained to both of them how the improperly designed business office was causing her neck, shoulder and arm pain and paresthesia in her hand.  I told the husband what changes needed to be made to allow his wife to work in a comfortable position eliminating the postural stress on her body.

The changes I recommended were done immediately, and within a few days and a couple of adjustments her symptoms were gone and she was holding her correction.

Had I not taken the trouble to go the extra mile to investigate what I suspected and see it for myself so that I could make specific recommendations to correct the situation; this case would not have come to such a rapid and successful conclusion.

Never overlook the Stress Factor in any kind of dis-ease.

In looking for the underlying causes of a persistent problem, always consider the stress factor. Stress can be anything that overly taxes the individual’s abilities to adapt.  It can be anything that overloads the body’s operating systems.  To be ultimately successful we have to correct the cause where we find it, be it physical, ergonomic, nutritional, chemical, emotional, electromagnetic or, most likely, a combination of factors.   We must be willing to think in terms of multiple causes because it is not possible to solve a multi dimensional problem with a one dimensional solution. Sometimes it requires a little detective work.  It always requires getting to know your patients.

The good news is that it really doesn’t take that much more time to provide a lot more service.  Granted, I can’t see 100 patients per day any more, but frankly, I don’t want to.  I allow more time for each office visit, but every minute of every visit is focused on the patient and their needs.  Every adjustment is based on the indicators that are found that day.  My wife Kiana keeps a detailed record of every adjustment so that I can always retrace my steps, to know what worked or didn’t. She works right along with me in the adjusting room. This is one of the important and effective changes I made when I began my retirement practice.  Patients can’t help but notice the continuous communication that takes place between Kiana and me about the details of their adjustment.  It tells them that what I do is very precise and that precision is important and accounts for the great results I am able to provide for them.

Focus all of your attention on the patient

In my office we don’t talk up the profession or try to educate the patients on the many benefits of chiropractic.  We show them.  When we do talk, or “educate” it is specific to the patient.  Our conversation is confined to the patient’s condition, progress and patient specific recommendations on nutrition, exercise or any other things the patient needs to achieve the best possible results.

I spend no time or energy on chiropractic orientation or education.  The patient never feels that he/she is being indoctrinated.  I don’t sell chiropractic.

Patients know that I am a chiropractor. That is why they come to me. Most don’t want to know all the whys and hows of what I do to help them. They just want help.  They come to me because I have a reputation of helping people and getting great results quickly. Of course, I am always happy to explain to any patient who wants to understand more and asks questions

In the final analysis, though, most patients don’t really care if you are a DC, MD, DO or ND.  They just want to feel that they are being very well cared for. They want to be treated like the unique human being they are — with a face and a name.  They want to be recognized, to feel visible, and to feel they are truly cared about and cared for.  And they want results that make them feel better and get well.

Many of our patients tell us that we make them feel that they are the most important patient we have.  That says a lot. And that is how we strive to make every patient feel.

People are willing to pay for that kind of individualized care, the kind of care that is disappearing in this modern world where robots are taking over and algorithms rule.  Person to person, individualized care has become a rare and valuable treasure. People are willing to pay for something rare and valuable. Especially when it provides them with tangible results they can see and feel.

My fees are not low but it is not unusual for people to insist on paying more than I charge.  Yes, it is not unusual for me to get “tips” – sometimes big ones.

I get fast results, I see each patient the fewest number of times possible. When making recommendations for future visits, I solicit the patient’s opinion about how often to schedule their visits.  They appreciate being included in the decision making process, rather than being dictated to.  This approach makes them feel that I value their opinion and that they are not being pushed into more than they want or can afford.  It is interesting to note that most people are quite realistic about the amount of care they will need to correct their problem.

There are multiple benefits to this interactive way of practice.  The patient recognizes that your goal for them is the same as their own:  That you want to help them quickly and economically and that you to respect them as a person and not just another billing opportunity.

They in turn will respect your professionalism, recognizing that what you do is so much more than a perfunctory slam, bam, thank you Ma’am, see you Monday, Wednesday and Friday until your insurance or checkbook give out.

Perception is everything.  When people perceive that you are putting their interest first, that you are serving, not selling, they will not hesitate to refer their family and friends.

This is how I practice.  My schedule is always full.  Most days I have a waiting list. I don’t have to worry about recruiting new patients.  My patients do it for me.  It is a very low stress way of practicing.  And it is, in fact, the way our profession was built.  It is the way legendary pioneers like Dr. Clarence Gonstead, Dr. Major De Jarnette, Dr. Clay Thompson and Dr. Burl Pettibon practiced.  I know because they were my personal mentors.

Schedule your patients in a realistic way that works for everyone, and that respects their time and yours.

Patients are more likely to make and keep appointments if they do not mean taking a big chunk of time out of their personal or work schedules. Patients really appreciate knowing that they will not have to spend a huge amount of time in my waiting room “waiting.”  I have found that because I respect their time, my patients are much more likely to respect mine.  I have very fewe “no shows.”

Kiana does our patient scheduling.  I owe much of our success and our always full schedule to Kiana’s attention to our appointment book.  She has taught our patients to respect our time.  We in turn show our respect for their time by staying on schedule. Or very close to it. Our patients seldom have more than a few minutes waiting time.

We actually try hard to keep our waiting room nearly empty.  That means things are working on schedule. Our patients like this. We respect their time and they respect ours.

 

 

 

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