The Prognosis Playbook: Under Promise and Over Deliver

Hey there and welcome back. I'm Dr. Vince Leone, executive producer and co-host of the Practice Builders Podcast. With my partner in crime, Dr. Kyle Pankinen, we deliver proven strategies to help you grow fast, specialize with confidence, and build profitable staff-run practices. Let's go ahead and dive into today's episode now. Hello and welcome to the Practice Builders Podcast. My name is Dr. Vince Leone.

And I am Dr. Kyle Pankinen, and we are Really super pumped about what we're going to talk about today. We think this topic will resonate with you and it'll solve a common problem in, I think, what I would call miscommunicating to the patient. And so Dr. Vince will introduce this topic and we'll dig in.

Yeah, absolutely. We're calling this the Prognosis Playbook: Under-Promise and Over-Deliver. And I think what Dr. Kyle is referring to is sometimes we take a little bit too much onto our shoulders in terms of what we can deliver. And because we want to help patients so much or move them into care, we tend to maybe overstate or overpromise with not having, you know, solid backing in terms of what we can actually deliver for sure, consistently, time in and time out. And so what we want to do is dive into Setting realistic expectations with the patient, pre-framing them for what success looks like so that when we get to the end of care, everybody is happy so that you have a patient that has gotten significant results and can tell their friends and family about the amazing, you know, spinal decompression experience that they had in your clinic.

That's the big key. Is doctors sometimes, I think, are getting themselves in a little bit of hot water with their patients. I think in in the sense that they're trying to get them signed on board to you know do a program, whether it's decompression or other niche, and they are overselling a little bit. And in the patient in their mind thinks, oh, this is this this is my solution. This doctor is my solution to this problem. And in their mind, when they think solution, they're thinking. Oh, I'm gonna get 100% better. This pain is gonna be a thing of my past once I do this program, and I'm gonna go on and be pain-free for years ahead. And don't get me wrong, there are some cases that is maybe realistic that that can be said for, but most of the time with these niches, we're dealing with chronic pain.

Yeah, exactly.

These patients have had surgery before, many of them. They've had injections, they have spinal cord stimulators, they've tried other chiropractors before, physical therapy, all kinds of injections. And by the time they come to us, many times we're their, in a sense, sometimes their last resort. Now, for you to tell a patient like that, oh yes, We're going to fix your problem. We're gonna get you pain-free. I don't know about you, but I don't see that in clinical practice. Not on a daily basis. I mean, you sometimes get miracle cases like, wow, this is amazing what happened with this case. But more often than not, what you get is significant improvement. And that is what we really want to talk about. So the solution to figuring out what you tell a patient relies in good doctoring. It is doing a good history, consult, examination, looking at all those factors that we talked about that might be in their past, and then determining from that, gathering that information, then determining, okay, What is the realistic prognosis of this patient's recovery here? And so we like to tell patients in specialized practice and so forth, we like to set an initial goal for them, which is, I'll let Dr. Leone speak about that a little bit.

Yeah, well, and to back up a little bit, I think we need to look at the frame of mind of a patient coming to us. Now, Dr. Kyle had alluded to it, but you have to understand, And you probably know this, but sometimes we need to be reminded more than we need to be taught. But these patients are very skeptical. Why? Because they're chronic in nature and they have tried other chiropractors, pills, potions, and lotions, gizmos and gadgets on Amazon. They've potentially either had surgery or had surgical consults. And so they've tried a lot of things and a lot of things have failed. And in fact, probably all of them have failed. So if they come to you and then you immediately say, We can quote unquote fix this. When someone fixes something, in other words, if I have a leaky faucet and my plumber tells me that he's going to fix it, well, I'm going to expect that thing to not leak. That would be a 100% fix. Well, this is healthcare. So if you have a skeptical patient that comes to you, and again, this, now this, this goes back into closing, right? If you have a skeptical patient that comes to you and you say you're going to fix it, in other words, 100% fix. It starts to send up alarm bells in their head because it doesn't feel realistic, right? Versus if you have, again, like Dr. Kyle was saying, is have a realistic prognosis. And we'll talk about what that is in just a second. But when you temper expectations, it tends to feel more believable because it is, it is the reality of what we're seeing. Because, you know, we have a lot of patients that go through our program and When you kind of talk to them in a very basic, realistic, um, uh, with, uh, basic framing of what is what they can expect, maybe what's a best-case scenario, right? But what is the realistic expectation? And then see if they see that as success. When I was doing neuropathy early on in my career, you know, a patient was 72 years old, They were diabetic. They had neuropathy for 5 years, if not more. And what I would immediately tell them is like, look, Mrs. Jones, just so you know, you're not going to feel 25 years old again. And so I want to make sure that you understand that and I understand that so that when we get to the end of your care plan, you know, we're all on the same page. So if you're at an 8 out of 10 in pain and I can bring you to a 4, does that sound like success to you?

Yes, hitting the nail on the head there, from an 8 to a 4. And so that's what I'm gonna propose. When you have patients that are coming to you, your history, your exam, your prognosis you're gonna give them. But I think that's the goal most doctors should set for their chronic pain patients is to, Mrs. Jones, the goal of our treatment is we want to try to do everything we can do to reduce your problem by at least 50% or more. That sets very realistic expectations. And for most people that live in chronic pain, if you had a protocol that had a really good chance, 85, 90% chance that they could get rid of half of their pain, that's life-changing.

100%.

For most people, that is life-changing. And I've had actually patients say that if you could really get rid of half pain, you have no idea what that would do for my life, doctor. And so that is always when I am giving my report of findings and my prognosis and things to patients, that is what I tell them. I am going to do everything we can— we are going to do everything we can do to try to reduce your pain by 50%, and anything that we get above that is gravy. It is a clinical bonus. Now, if you look at published research studies, They have this thing called meaningful clinical improvement determination. Well, what is that in English? That means it's the minimal amount of improvement, whatever intervention that is, surgery, therapy, chiropractic, whatever, it's the minimal amount of improvement that a patient deems as worthy of their time and their investment. In other words, they'd say, and that is 30%. In other words, a patient, they say, if I can get 30% improvement, to me, this, whatever intervention I did, this was worth it for me. So even at 30%, doctors, you are still going to have patients that have some degree of satisfaction with that. So we are going to shoot for 50% and we are going to deliver on that the majority of time. So I've been doing niches and decompression neuropathy, chronic knee for several years, and I keep statistical analysis every year of what percentage of patients that's what we accomplish, that we get them 50% or more better. And statistically, it's decompression that usually is 85 to 93% of cases. It's somewhere in that range that you get to that level of relief. Chronic knee pain, it's pretty much similar, 85, 90%. Neuropathy is a little nuanced because depending on the type of cases you take on, because some are really complex and some are more straightforward. But the bottom line is this, that's the level that you want to, in a sense, not promise, but you want to make your goal towards that.

Hey there, it's Dr. Vince. And if you're getting value from this episode, please make sure to hit that subscribe button so you never miss an episode. And if you know another doc who's ready to grow their practice, share this with them. It might be exactly what they need right now. Thank you in advance. And now back to the show. Yeah. And we've been blessed at Specialized Practice to have Kyle, Dr. Kyle, tracking these protocols since 2020. Right. So that's actually one reason why doctors join our program, because they can use a protocol that's already helped thousands of patients around the country. Because again, it comes down to confidence.

Right.

Confidence that you know what the problem or the pain generator is, confidence that you can help the patient. All that then translates to the patient. And then if you combine that with just, again, pre-framing, managing expectations, you'll probably— if you just try this out, I think you'll be pleasantly surprised at the response you get from patients because it's going to engender More trust and rapport versus the doctor saying, you know, it's good, this is gonna be a miracle. Not that you use that word, but when you say we're gonna fix, that is like a miracle. That is giving a 100%, you know, success rate. And it's just, it's potentially setting you up for failure. And I feel like sometimes doctors do this when they get a little desperate trying to get patients under care. It's not your job to save this patient's life. It's your job to one, Figure out what the problem is, and 2, whether you can help. Those are the 2 things, right, that you should be focusing on. It's not your fault that the patient didn't take care of their health prior to coming in. It's not your fault if they don't follow your recommendations throughout care, though we want to do everything we can to make those expectations and guidelines clear. But really, your responsibility is to be an excellent doctor, And make your best recommendation for care and then manage expectations. Because again, we're not talking about common neck and back pain patients where you can adjust them 6 times and they're out of pain perfectly. That's not who we're talking about here, guys. We're talking about chronic back pain patients. We're talking about chronic neuropathy patients, chronic knee pain patients. These are complex cases by and large, and you need to increase your clinical skill sets so that you can determine the pain generator and the prognosis for the patient.

Yep, that's really what it's all about. And then the, the other thing I would like to bring out here is that if you look at research on spine surgery and what spinal surgeons in their own literature, what they consider a successful outcome, Is if a patient gets 50% better following the surgery. So what I always say to doctors is if surgeons do not hold themselves to a higher standard than 50%, and they are treating the tough cases just like we do with decompression, same patient subset. These are disc patients. These are spinal stenosis patients. If they're shooting for a 50% improvement, why should we who are not doing surgery, we're doing conservative treatment, why should we hold ourselves or hold out there that we're going to do necessarily better than a surgeon? Now, I'm going to share some studies at the Decompression Summit coming up here at the end of the month that shows that actually we do do better than surgeons. But nevertheless, That's what you wanna hold yourself out to. And then, you know, when you get that patient and they get to the end of care and they're like, Doc, I'm 80% better than I used to be, they're really excited because—

You've overdelivered.

You've overdelivered. So you've, in a sense, you've underpromised and you've overdelivered. Delivered. And most, not all, but most cases that we treat with spinal decompression protocols, neuropathy, chronic knee pain, most of them do get 70, 80, 90% better. And those are happy patients. They got their life back, they got their pain reduced. They're gonna tell other people about their results. And your word of mouth is going to spread and grow from that. It's all based upon results, but you don't get that— excitement if the patient is thinking, oh, this doctor told me he was going to fix me and I'm only 70% better. You see the difference?

100%. Because I've, you know, I've heard, you know, stories from doctors where they have problem patients that they get significant results, like 75% improvement, but they're still unhappy. Well, That was most likely a communication issue from the beginning of the relationship. And so I think for doctors that are, you know, they're wanting to be experts in these particular niches, they want to position themselves as to be the go-to doctor in their community for these particular niches, having this knowledge base of what other healthcare providers like a spinal surgeon looks at as a success barometer is important because you can share that with your patients. When you're in your report of findings, I mean, do you think this would be helpful? Hey, did you know there's, there's 125,000 spinal surgeries every single month? That's about 1.5 million a year. Do you know what their success standard is? 50%. So if, and if our success standard is 50%, potentially better, wouldn't it make sense, common sense, to explore all the non-surgical solutions first where you don't have to have 6 months of rehab, you don't have to risk all the complications of surgery. When you start to share again that knowledge base with your patients, they're looking at you like, wow, I didn't know that. And if you're sharing information that is published data, uh, with them, they're certainly not aware of this information. Again, it just engenders trust and rapport and sets up the relationship for success.

Yeah, a statistic I'll share is that A first-time spine surgery, let us just take spine surgery here. Depending on the study you read, the failure rate is anywhere from 10% to 46%. So it is probably somewhere in that range, is somewhere between. So it is at least in the 20% range of surgeries, first time that fails. A second spine surgery is a flip of a coin. It's 50/50. 50%, it helps. 50%, it doesn't. A 3rd spine surgery has a 70% failure rate, 30% success rate. A 4th spine surgery, 85% failure rate. A 5th spine surgery has a 95% failure rate. So you only really get one good crack at it.

Got one shot.

One shot. So that's why I always tell patients, you should do everything you can to avoid that first spine surgery and to leave it for your absolute last resort. And that's why if you haven't done decompression yet, you're missing a big step that you should do before you go to surgery. Because if that fails you, then you know you've done the best possible non-surgical treatment that is available on the planet. And if that fails you, okay, maybe that is your only option left is surgery.

Yeah, surgery's not going anywhere. And, and oh, by the way, surgery is not free. This is something that you can also share with your patients. There is going to be an investment on your part. It could be, you know, a 10% copay. And oh, by the way, surgeries are somewhere in the neighborhood of $150,000 to $250,000. So if patients think they're going to go to surgery and have insurance cover everything, no, no, no, no.

Uh-huh.

Good luck. You are going to be on the hook for a significant amount of money, and it's going to be a lot more than a $5,000 Decompression plan. And I've shared this story in the past, and I'll share it again because I think it's important. I have a good friend that works for Medtronic, which is— they make the pins and the screws all the way up to the million-dollar robot. Uh, he's in the ER every single day with spinal surgeons. I asked him, hey, how's business? He's like, hey, they're lined up around the block, and half are redos.

Wow.

And oh, by the way, he recommended his Mom, 83 years old, to have spinal surgery. She was in chronic back pain, about 5 to 6 out of 10, to the best surgeons and best surgeon in Boise, Idaho. She is now not doing so well. And he will never— he said literally, I'll never refer anyone to spinal surgery again. This is a guy that makes his living from this particular lane of service. So there's— it's not that surgery is not in some cases necessary. That's not what we're saying. What we are saying is that the more information that you have is the more information you can share with patients. And from our perspective, all nonsurgical solutions should be explored prior to going under the knife.

Yep. Only 2 to 4% of all spinal cases ever truly require surgery. That means, that's what the studies show. That means 96 to 98% of the cases out there need the type of care That you and I deliver, doctors that are listening to this. And so you need to, but you need to know, you need to have the protocols and the expertise and the confidence and the training to take on these more challenging cases, the 10 or 20% that cost the healthcare system 90% of the cost. And those are spinal stenosis and disc herniations. So That's most of what I got to talk about on that, Dr. Vince.

Well, I know, I think we fleshed that out really well. And hopefully this has landed with all the doctors that are listening because, you know, if you're not super confident in your clinical skills or, you know, your ability to, you know, determine if a patient is a decompression candidate or not, that's a symptom, not a cause of the problem with your decompression lane of service. The cause is that you don't have the clinical skill sets. Now, why is that spinal surgeon so confident? Well, probably because they have about 15 years of, uh, you know, medical school that went under— that they went through to be able to perform that surgery. How much schooling, how much continuing education, how much investment have you done? Have you put into your skill sets as a decompression doctor? If your confidence level is not high, then it is not enough, right? And that's— And that's what we do at Specialized Practice is help doctors increase their clinical skill sets, have proven protocols, have the systems, have the staff trained, have the marketing to reach these patients that need our help. So just to wrap this up, um, by learning this, or at least starting that, the process of recognizing, hey, what is a realistic prognosis? How do we talk to patients? Hopefully that you can take this information and use it. tomorrow or next week in your report of findings to manage expectations and engender that kind of trust and rapport with patients so that you can create a successful relationship. They get great results. And oh, by the way, if it's greater than 50%, wonderful.

Wow. Well said, Dr. Vince. And that's key. Confidence is key. If you don't have the confidence, then you got to do something to get that confidence. And usually it's getting more training or getting under some coaching of somebody that's been there and done that, that can guide you through the process. And that's what Dr. Vince and I are here for. We're here to help. And we've both done it, been there and done that, and been in the trenches and have done well in the trenches. And so We're here to help.

Absolutely. So, um, that's going to wrap it up for this episode. Hope that gave you a lot of value and, um, that you can turn around and use that in your practice. Of course, if you want to learn more, you can always visit Specialized Practice. So that was our Prognosis Playbook: under-promise, over-deliver. Uh, try implementing this. I think you'll be very happy with the results. So for this episode, we'll wrap it up. And, uh, again, if you haven't given us a 5-star review, Please consider doing that. And if there's anything or any topics that you would like us to cover, feel free to shoot us an email, support@specializedpractice.com. We will absolutely take that under consideration. So for Dr. Kyle, I'm Dr. Vince, and we'll see you all on the next episode. Hey, it's Dr. Vince again, and hope you enjoyed that episode. And if you're ready to grow your practice fast with high-value decompression patients, then the Decompression Accelerator could be a phenomenal option for you. This is our 90-day sprint to help you scale with proven systems, staff-driven protocols, and full marketing support. And it's all guaranteed. Spots are limited. Head to www.decompressionaccelerator.com to learn more.