088 - How to Turn Progress Exams into Patient Breakthroughs

Adjustments are like handwriting. Everyone's handwriting is slightly different and it takes a little bit to adapt, but the outcome is the same, which means you can read the message. Right? So it's the same when it comes to adjustments. We're learning, figuring out your body, and you've been adjusted by three different cars here. So everyone's slightly different, but it's like handwriting. And you know what the results are going the right direction. So it's telling us that we're getting the message through your nervous system, how it should be getting there.

Hello and welcome. Welcome to Build you'd Remarkable Practice podcast. This podcast is dedicated to chiropractors who are in the seasons of launching and building their practice. Join myself, Dr. Lona and my co host, Dr. Bobbi as we have conversations each week as it relates to building the practice of your dreams. And remember, you can have a remarkable practice as part of a remarkable life, not instead of one. We are here to lead you on the way.

What's up, team? Welcome back to the Build your Remarkable Practice podcast with the fantastic Dr. Lona Cook and myself, Dr. Bobby Lojasvic. And we are fresh on the back of some immersions and inspired and pumped and ready to help you grow your office. But you know what, before we do that and before we get into today's episode, you know, the immersion that we had now a couple weeks ago was fantastic. Lona, I know you've been having a lot of mastermind calls on the back end of it. What are some big takeaways? So we had a marketing attraction immersion, and I'm putting you on the spot here. But if there's like one, maybe two takeaways that you're like, hey, this is what we're going to roll back to my team, and I think it's going to be useful for everyone on the podcast to hear in this episode. What did you get out of the Immersion? As a. As someone who was an attendee, I know that obviously you're participating in speaking, but what's something you got out of the immersion that you want to implement into your office going to help you guys grow when it comes to marketing?

Yes. All right, well, Bobbi, you were. You were a hot spot in the immersion. It kept coming up in my masterminds today as well. But for me personally, one of the things I love that you told us and demonstrated was just how important our video footage for meta and for different things that we're doing on social is to keep people's attention. And so to have more props and to Have a moving element of like walking and talking or bringing people with you or just like doing something bizarre, but it catches people's attention in order that they actually might watch it a second time or actually see what you're talking about. That was my biggest takeaway of like, okay, we need to stop being so boring on some of the things that we're shooting. So that was a big one for me is our creation of our content.

Yeah, I've heard that actually a few times now. So once you see, you cannot unsee it. So I was sitting on the plane on the way in and I was like, look, learn from the pros and cons. Literally since then, I've sh. I've told multiple people and they're all like, oh my God, yes. And what I'm talking about is when you look at a movie and even if you look at TV shows, but especially like world class movie productions, they've got to hold your attention for two hours, right? So you can learn some tips from the pros. And while there's many things to be learned and how they do that and how they build a storyline, the character and the sequence of stories and, you know, all those things that go through it, one of the big things is they can hold your attention. So here's what I noticed, right? I learned that humans are like goldfish. And so if you, next time you're watching a movie, just count how many seconds there are between either a scene changing a view, changing so a point of view changing, a zoom angle changing a focus point changing some motion occurring in the picture. And I sat on my flight from Sydney to Phoenix. So it was a good, whatever it was, 15 hours, and for about an hour at least, I was in awe of watching three TV screens in front of me, three different movies. And I was just counting, scene change, 1, 2, 3, point of view change, 1, 2, zoom change, 1, 2, 3,. And I was like, literally I could not find one scene. The longest that I got was six seconds with one scene staying the same. So I looked at that and I go, wow, look at that. Is there not a lesson to be learned there when creating content? I think the answer to that is absolutely yes.

Yeah, definitely. So that was, that was probably one of our biggest takeaways. And then from today, one of the other chiropractors was again motivated to do better job of getting his message out there, particularly on social media with his team. But also he had an epiphany of like, I've been thinking of adjusting and my hands as the most important thing that I do. And instead, like his leadership, his CEO, his vision, you know, he had that positioning change where he realized when you said actually adjusting potentially could become a not priority for you because you can duplicate your hands, you generally cannot duplicate yourself as the visionary and the leader of the practice.

Yeah, I would say his mouth is more important than his hands.

What comes out of it, which, you know, you could trace that back and say, well, that means his mind, that means his heart. Right. And so in turn that means vision. But, you know, if you couldn't adjust, could you still make an impact and grow a massive practice? You could. If you're on purpose and you knew other skill sets and you could speak and you could generate demand for other people to adjust. Right. So you got it. Yeah, spot on. But today we are going to be talking about retention. I know that we just come out of attraction version, but it is time for retention. And particularly when we're discussing today's podcast, we said, okay, let's speak on a topic in retention, which is, I know it's mentioned. When you hear this topic, it's not going to be a surprise. You'll be like, oh, yeah, I've heard that before. However, it's, I would say severely understated. Which means that even though it's like mentioned, people hear it like, yeah, yeah, we're doing those. But so often when I actually unpack and double click these, they're not doing them that great. Right. And it's such a missed opportunity for creating long term relationships inside of our practice and ultimately cultivating retention so people don't drop out of care. And so that system, guys, that we want to double click on today and we want to go deeper on is your progress exams and progress reports. Because we know that people are going to hear this and go, oh, yeah, I do progress exams and progress reports. But hang on a second. Do you do them world class? Are they driving your attention? Are your stick rates people completing care plans super high through the roof? If the answer to that is no, then I'll suggest you have room for improvement in progress reports. So why don't I hand it over to you, Lona, first of all, so why don't you take it through progress reports? We know that they're regular checkpoints. How do you guys do them in your office? How often do you do them? Where do you do them? Do you separate the progress exam from the progress report? Take us through. How do progress reports roll in your office so we can see what we can learn?

Well, And I, as you were saying that I was realizing, you know, I just recorded with Dr. Eric last week and it was on getting your patients to answer that question of what would happen if I stopped getting adjusted. Right. And we were talking about, you know, that's part of the goal of having these, this experience that you're taking the patient on the journey and you're table talking, you get to these progress exams and you're, you're checking in to see like, what's their understanding, how far have they come. And so this, this pairs nicely with the last episode. So if you didn't listen to that, go back and listen to that. So in our office, we do our progress exams every 12 visits and we actually do the report generally that same visit, unless for some reason we needed to split it. So we do our thermal scans and our EMG scans again on those visits. Every 12 visits we're comparing and contrasting. So in our office, the tech ca will do that, bring the patient back, do the scans and print out the previous and todays so that we can compare and contrast. And obviously we also have the first exam note and the patient goals and where we're at today. So that I think one of the things that I've noticed over the years is that most people do not slow down enough to come prepared to their progress exams. And that's part of the issue is you can't ask the right questions if you don't recall where the patient began. And so making sure that you're prepared to remember the goals from the beginning as well as Sometimes even by 12 visits in, people have had radical change already and they forgot where they came from. So, so much of the progress exam is connecting again so that we're on the same page and we can make sure that anything that we need to tweak and have a conversation with, we can do that. But it's a critical communication checkpoint as well as a re remembering of where we came from and where we're going.

Yes, but on the mark, one thing that is essential when you prepare for your progress reports is that you do exactly that. You prepare for them. And prepare means that you know, the person in front of you. So my early days, you know, as I started to get busy, I was like, oh, progress report today for loner. And then I'll kind of wing it. I'd be like, hey, Loner. So this has changed. That's change. And in the moment that you had some objection or some pushback or some, you know, question outside the realm of like, what was coming, I would get a little bit on the back foot. And what I realized is I'll get on the back foot because I didn't know your full case in detail. There was things missing. For example, I didn't have your X rays attached on file. I didn't have like all your previous scans there on file. I didn't have your previous goals, your history all there on file. And what I recognized then is that I'm trying to hold a position on something whether that means you're doing well, where you're not where you need to be. And I was doing that based on premises that are not 100% convicted and sold in my mind. So it's like when you're trying to have a discussion with somebody around something that you don't have complete conviction around. Good luck. There's an old saying that says the most certain person always wins. So if that practice member was more certain about their non responsiveness than what I was certain about, like where they're up to and how their body's progressing, then they're going to win. And if their most dominating thought was the fact that I'm not where I should be at this point, then that dominating thought is going to win out in this example.

Right.

So I love that you brought up like the preparation key. So on that lineup, have you got any high level tips? Because I agree with this 100%. How do you guys prepare for a progress report? Is this a pre shift huddle thing? Is it like a before flow thing? How do you guys prepare for your progress report so you have that conviction?

Yes, it's definitely a pre shift thing. You know, our check in CA will prep the note from the last time an exam happened so that we can. So the doctor has both ready as well as any digital forms that have already been filled out in advance. Now if the person slides in in the last minute and doesn't have the digital forms done, of course the doc needs to spend that time before they go in the room reviewing both side by side. I think more times than not, I think it's the patient has forgotten where they've come from as well. Because chiropractic is amazing and the brain has a way of just forgetting where it came from, which is a beautiful thing. Just like you know, you have a baby and you forget maybe some of the intensity of that experience and then you want to have another baby. It's like we have to take people back to the progress or to where they began and the progress we've made many times and that you can't rely on just remembering those things. So going back to that original note, the original goals and also the original complaints to review not only objectively what was things you notated on, but subjectively, what were they telling you? Um, because I think many times they might say they're not making progress and then you're like, but you didn't comment on the fact, you know, your digestion or oh yeah, that's better. I haven't been taking my reflux meds. Oh, okay. So something did improve, even though maybe it wasn't the thing that they wanted help with or their thinking isn't improving.

Yeah, no, spot on. So I agree 100% like what you're saying. Here's the other thing that I've learned from that too, that time is important. So people sometimes have the wrong expectation of and when things should improve and when things should start to see changes. So I mentioned before earlier on we didn't have X rays on people's files. If you're doing X rays as your protocol, you need to ensure that you have original X rays updated. X rays, everything there on file. Why? Because when it's there on file, you can really just re anchor yourself to initially what was going on with that person. So for example, what happened to me is I wouldn't look at X rays and then when we started to put X rays on all files and, and before in the pre shift title I'll review an X ray of all my progress reports and I'd be like, oh yeah, that person's a phase two subluxation. You know, they've got disc degeneration of the phase two likely been building up for many years. When I would like get to the bottom of that, I would convict myself. So if we're at week four and the person's look doc, I'm still getting these tenderness that hasn't changed. I'm sky high in my certainty and I'm like, look London, do you recall Bang. And I'll pull your X ray straight up. What phase of subluxation with you? Well, I was to begin with a phase two. Exactly how many years was that building up for? And in my mind I'm like, that's been building up for 15 years. So four weeks in, is there a possibility that this might still be tender and painful, but it's still actually improving? Absolutely. It's like the equivalent of someone who's, let's say 150 pounds over a healthy weight and they start exercising for two or three weeks. And they're like, oh, I'm disappointed, I'm still overweight. It's like, hang on a second, you're 150 pounds overweight, so your body's going the right direction. But we know that it's going to take time and you're going to start to see changes in stages. And so if you're making an assessment based on this stage now, you're selling yourself short and you're leaving the issue there. So sometimes all it would require is a re anchoring around that and then bang, they might have one or two more questions or. And they're clarifying questions. They might just be like, yeah, you know, well, I guess I was just hoping it's going to happen quicker, give your body time. Because one thing that we know is the bodies designed to be healthy and give it the right environment for a long enough period of time that's going to go in the right direction. So I love that you said prepare because, yes, we ensure that before pre ship title, as a dc, you're prepared for all your progress reports that are coming up. And then here's another little thing that we do when we're adjusting the person who's got the progress report. All right, so we always adjust them first, they've done their exam the previous visit. All right, with PowerPoint, we adjust. We have in the screen in front of us there, their whole file. And in the file is written what was their goals, what was their chief complaint they came in with, what phase of subluxation were they? All right, then we have in there some information about them. So they're fit, healthy, want to get back into CrossFit. We have the X rays right there and their poor score scans right there. So we can, while we're palpating, just relook at the X ray and bang, reink myself to that conviction from day one so that I know exactly how I'm going to enter into this conversation. Right. So that's how we prepare for progress.

That's great. And I like what you brought up there too, of like how you come back. We're onto like phase two and giving them analogies to, to help them understand that this isn't work that's done overnight. For those of you listening that use scans, I think a thing I hear sometimes is like, well, I'm worried that the scans aren't going to look better. And I say, and I think my response to you is, again, what's the objective here? Like, yes, the scans should be improving, but many times there's change that shows up on the scan. And so I'm being comfortable talking to people about like, you know, this part may be changing. We're noticing a different pattern here. This part isn't. We're just going to keep paying attention to this. This is why we use our exam findings as like they're all stacking on top of each other. It's not just one finding that determines if they're making progress or not. It's this whole look at the patient experience as well as the exam findings that helps us then continue on the path with them and give them the best recommendations to keep moving forward.

Spot on. And I think there's this one quote by BJ which for me summarizes it all beautifully. And I recommend that you keep this in the back of your mind whenever you're doing a progress report. And the quote that BJ said is, when in doubt, okay, don't question the pincer principle. Instead question its application. So what happens if the scans aren't changing? Chiropractors are too quick to default to. It's not working right. Adjustments aren't working, things aren't changing. All right, first of all, like you said yourself, Lorna, any change is good. Whether there's more colors, less colors, it's changed, it's fantastic. It's a great sign your body's changing, how it's adapting. Great. What's not good is that the, the scans look almost identical, which means that those patterns are stuck and the adjustments aren't impacting the nervousness need to be. Now if that occurs, which that in itself is going to be way more rare than like, oh, there's more colors now as an example, depending on what you're using. All right, when in doubt, let's say the scans look exactly the same or you're doing a posture profile that looks exactly the same. You're doing a re X ray, looks exactly the same. Don't default to this ain't working. Default to. Hang on. Let's look at the application. And the application means first and foremost, did this person get adjusted in rhythm and follow their care plan? Yes or no answer, right? If they missed adjustments, you didn't apply properly. They didn't apply properly. You guys, the team didn't apply properly. Right? That's the first thing. Number two. You know, we talk about a three legged stool, so are they breaking the bad habits that are leading subluxation? Because we could adjust them three times a day, but if they go back to a sick and toxic deficient lifestyle and you're not educating on that. You're not applying it properly. Right. You're adjusting them, but you're not applying the full spectrum of helping someone's body heal. Or number three, are they adding the corrective exercises? And this is an easy one for me, learner, because I can check in with the person and go, hey, I can see you being great with your exercises. Right, sorry. I can see you being great with your adjustments. Part of me, you haven't missed a single one. Tell me, exercises that we give, things like dental and whatnot. How you been going with the dental? And I can tell through the person's response how well they've been going with it. It's kind of like the high school teacher, they used to say to me, bob, how'd you go with the homework on Friday? I'd be like, yeah, good. Really good. And then when they go, great, what was the biggest takeaway you took out of chapter three? And I'd be like, oh, yeah, chapter three. I really enjoyed the part where, you know, Hamlet did the thing with the skull. They're like, what specific thing did he do with the skull? And then cooking. My teacher's like, you didn't read the chapter three on Friday night, did you? And. And we're like, no, I started, but kind of. I got a page in. I didn't complete it. Gotcha. It's the same like that. How you going with the den roll? Fantastic. Great. How often are you doing it? How many times a week? Two or three. Two or three. How often should you doing it? I think you said four, five, actually. Right. Five plus. How many minutes are you on it for? Oh, about five. How many minutes should you be on it for? By now, I think you said about five. No, 15 to 20. Is your head hitting the floor? No, it's not hitting the floor yet. Well, it's no wonder because you've probably been doing the dental at like 3 out of 10. Right. So then that shows you the corrective exercise. I haven't been applying that properly. So when in doubt, don't default to questioning chiropractic. The principle works. Default to questioning the application of the principle, which often means, did they get adjusted in the recommended schedule? Did they break the bad habits and do they do the corrective exercises? And usually you'll find the answers in one of those.

That's great. And sometimes it is like, you know, saying, okay, you know, I'm going to try a different technique with you, or I'm going to, you know, I'll change sometimes if I'm used to starting people face down. Like, sometimes I find that the order we adjust, like the subluxations, we want to address that even that change, maybe I'm adjusting the same areas, I'm just doing them in a different order will lead to a different result with people. Again, bodies are dynamic. Sometimes we have to come up with ways to help the patient understand that we are literally being artists here, trying to figure out what's the best approach for this person. Knowing that chiropractic works. Right. We just have to, like, know that our hands and what we're delivering, we're doing our best job with that person, given that we're learning their spine at the same time.

So, yeah, totally. And the key is communicating that in a way that it doesn't come off across as like, I'm still figuring this out. It's like, no, there is a science behind this. We're putting a force into your spine which impacts the nervous system. And the specificity of that force is key. But I like to say adjustments are like handwriting. So everyone's handwriting is slightly different, and it takes a little bit to adapt, but the outcome is the same, which means you can read the message. Right. So it's the same when it comes to adjustments. We're learning figuring out your body, and you've been adjusted by three different Cairos here. So everyone's slightly different, but it's like handwriting. And you know what, the results are going the right direction. So it's telling us that we're getting the message through your nervous system, how it should be getting there.

Yes.

So tell me this, lona, why are progress reports so effective? Well, to bring it together. What is it about them that leads to such high retention when done right? What's the reason for that?

Because we get on the same page and we have the same expectations moving forward again. So the communication piece, we get re reacquainted with each other in that moment and have the agreements in place to keep moving forward.

Yeah. So basically what you're saying is the successful principles that underlie every relationship, which means that we start off with clear expectations, agreements, and then, you know what, we regularly check in and we have discussions, we have meetings, and it's the time to hear concerns. And it's a time to also share wins and victories. And if there are concerns, don't shy away from those. It's okay. It's an opportunity to actually get this person further committed and further reinforce. Is that right?

Yes, totally.

All right. Well, I think, anyway, that brings us guys to the end for the podcast today. So whether you're doing progress reports or not, if you're not, start doing them. If you are, ask yourself, how can I increase the effectiveness of how I'm doing them? All right, and we shared some strategies on it today. Remember, when in doubt, don't question the Principal Questions application, but you've got to make sure you're prepared for your progress reports. Don't go into those like, all right, well let's try and wing it. The more prepared you are, the better outcomes you get. Not just for yourself, but for the practice member, which is the most important thing here. And it's how you cultivate long term relationships. I'll let you rock and roll before your computer blows up and I will catch you guys really soon. Have a great week.

Thanks for listening to this episode of Build you'd Remarkable Practice Podcast. Remember, what the world needs now is chiropractic. And what chiropractic needs now is more successful chiropractors. If you like the podcast, please subscribe, share with your friends and leave us a review. And if you'd like to connect with us personally, please click the links in the show notes to schedule a call.

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