Struggling with Referrals? Here’s How to Fix It Fast! | Podcast ep. 471

Foreign hello and welcome to the Evidence Based Chiropractor. I'm your host, Dr. Jeff Langmaid. Happy holidays. Thank you so much for tuning in and if you've been a new listener or maybe following along for years, just thank you. Thank you for paying attention. Thank you for working to improve your communication, hopefully through this podcast each and every week and and this week will be no different. We're going to talk about referral systems, but we're going to talk about it on the back of a research study that I recently came upon brand new that discussed the effectiveness of strategies for implementing guideline concordant care. We know tons of doctors out there are doing non guideline concordant care. We're going to talk about that and then we're going to dive into the findings of this study and also some big takeaways that you can use starting like literally today to start helping other doctors be more guideline concordant, which, guess what, results in more referrals into your practice. Now before we get started, I want to say a few words about neck care. The best objective assessment for cervical spine on the market, bar none, it is an objective assessment tool. They have just updated their software. I was speaking with their CEO. It is awesome. We're talking about reliable assessments and exercises for neuromuscular control, proprioception, range of motion, sensory motor integration, all of that and much more@netcare.com and I will drop that link down below. But as I said at the top, we're gonna talk referrals and we're gonna talk about this in the context of the effectiveness of strategies for again implementing guideline concordant care. So the study I'll be highlighting briefly at the top is titled Effectiveness of Strategies for Implementing Guideline Concordant Care in Low Back Pain A Systematic Review and Meta Analysis of Randomized Controlled Trials. I'll drop a link down to the show notes. We'll move through the study pretty quickly. They basically highlight the fact, as we know, that clinical practice guidelines are really important resources to do a couple things. One, to improve the quality of care for low back pain in this case. And how do they do that? Well, they do that by synthesizing the available evidence and providing recommendations for for best practices. And they highlight what we also know to be true, which is, hey, there's a time lag. Just because something is produced, meaning published today, doesn't mean it's implemented tomorrow. And that gap of time I think can be expected. I don't know what the average is, but I know specifically relative to low back Pain care. This lag has been way too long and they're highlighting that in this study as well. One of the things that's nice that they point out, as we know and you know by listening to this podcast, is that guidelines have shifted dramatically over the last five, 10, 15 years from a focus on analgesics and pharmacological care to the complete opposite movement based healthcare. You and I, what we do, limiting and recommending against, in many cases advanced interventions, advanced imaging and recommending against the use of analgesics and certainly opioids. Now the dichotomy here is we know and I know in your town, you listening in your town right now. Today people are prescribing opioids and NSAIDs and diclofenac and all of these things for people that are going into their practice with low back pain, that is a problem and it needs to stop. And that's what we're going to talk about on today's episode. This systematic review was really looking to evaluate the effectiveness of different implementation strategies, specifically providing education advice, discouraging routine imaging use when they say that most of the time it's advanced imaging and reducing analgesic use. So a really good premise from the study perspective was to look at that. Now here's kind of the punchline as we get towards the end and why we're going to move on to practical implementation, implementation steps. Basically they found, man, this is really hard. They found there's a lot of non guideline concordant care out there and this is bifurcated. In other words, this is not only about education of the provider, but it also is about education of the public. And that is meaningful. Now here's the great news. As chiropractors, as business people in our communities, as entrepreneurs, often we have a large focus on the education of the public, whether it's through our websites, whether it's through the events we go to, whether it's through advertising, whether it's through videos. Maybe you're shooting. We as a profession, chiropractic has had the upper hand, I should say, in terms of educating the public for a really, really long period of time. Now we can talk about whether we've done as a profession a great job or not so great job. But many of us have that as a core competency of what we do within our business. Even if it's just internal promotions to get referrals. If you're more of a referral based practice, wonderful. Chances are you're doing public education each and every day. When you at least when you're speaking to your patients, if not far above and beyond that, again, on social, on your website, et cetera. So that's a great component. But I can tell you what we've done well there. We've done exceptionally poorly as a profession, building referral relationships and building education with other healthcare providers. And this study basically highlights what we know to be the truth. There is no institution that's going to magically do this for you. This is about you taking action. The onus is on you in your community to say this is important to me. And I'm gonna go one step beyond that because it is more than just about you. This is important to the health of my community. And when you truly believe that what you do improves the health of your community, you can't not have a referral type marketing system implemented in your practice. It's counterintuitive to the goal because as I said at the top, every day in your community people are getting bad choices. They're being influenced. On medications, on advanced imaging, on epidural steroid injections when not necessary, on elective surgeries when not necessary. There's a time and a place for that and it is fractional compared to how often that's being done in your community.

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So what can you do to change that? A couple different things. This is obviously where we live. We with the evidence based Chiropractor, Maryland Connection program is these referrals. And since it's the end of the year, I'm just gonna give you a highlight reel as far as here's things you can be doing. We can help you get it done a heck of a lot faster, a heck of a lot cheaper with systems and processes. But I'll throw out all the information to you right now so you know how to build relationships. Because I want studies like this to stop being produced. I don't want there to be studies saying, wow, there's no organizations really doing this and it's the guideline, concordance is not there and there's a lot of people getting Information, education and treatment that is quite frankly more harmful than good, that needs to stop. But I'm going to say it stops when you and I take massive action. Not a little bit of action. Massive action. And our profession decides we're going to take massive action at an individual practice level. So with all that being said, let's dive into the meat of this. How do we overcome these challenges of referrals? There's a few different things. One, keep doing your public education. Everything you're doing to get out there, to build referrals, to talk on social, to write blog posts, shoot videos, whatever it is that you are doing from a public education perspective, keep doing it. Because it's an important component when these patients go to their other doctors, is for them to be able to ask and or request coming in to see you or if there's questions that even the doctor has to the patient, that the patient can accurately answer, that really, really important. The second step gets down to where we're going to dive into today, which is how do you build those referral relationships directly with those other healthcare providers? And I can tell you the process, it's not super complicated. That's the good news. But consistency, as with everything in life, reigns supreme. So as we've identified the best practices to get the best result, we've identified within MD Connection, the evidence based chiropractor. Three pillars of relationship building as you might have heard me speak about in the past. Number one are sending case notes, number two is sending research updates and number three are taking meetings when you have the opportunity. So I'm gonna skip a little bit of how you build a target list and do that sort of thing and dive right into those pillars and the case notes, research and meetings. The three pillars all have a different how and a different why. And that's what I want to touch on today. Research. Excuse me. Let's start with case notes. Many of you listening have probably sent some case notes in the past. Some of you have never sent case notes in the past. Here's the mental shift in the how and the why. A case note is a marketing tool that happens to have clinical information. That is a key shift. A case note, as I define it, is not an insurance note. It's not a personal injury narrative. This is. There's a time and a place for those things. But case notes should be updating these other doctors on the fact that you exist. Number one, you're co managing with them, number two, and you get great results. Number three, that is the purpose of a Case note. Now if a doctor wants more information, wonderful. But do not punish everybody else by sending too much information. So when do you send the information? Is a great first question. Which would be on your evals and your reavals exams. Re exams. What do you send? Second great question. You're going to be sending information on patient name, date of service, diagnosis and treatment plan. Who did you see? Patient name, when did you see them, date of service, what did you find? Diagnosis and what are you going to do about it? Treatment plan Keep it simple. A case note should be less than one page. And again, why? Because we want to reverse engineer success. If it is single spaced, 18 pages, I can guarantee you that other doctor is not looking at it. But if it is simple, easy to understand, easy to read, that is the impact. And here is the ultimate shift I'd encourage you to make and that's to think about your case notes. Like B2B testimony like B2B testimonials business to business testimonials. We all care about Google reviews. Well, what is a Google review? It's a B2C testimonial. A business to consumer testimonial. Really? It's a consumer to consumer testimonial. But don't forget about the other side of that coin which is the business to business testimonial. I view a case note just as important to ship out my front door as I do a review to be had on Google. Why? Because I know if I'm sending an eval and a re eval, I'm going to have two case notes per patient in my practice. Think about how many patients you've taken care of in the course of your career. Maybe it's 50, maybe it's 500, maybe it's 5,000. We'll multiply that by two and that is how many case notes can, can and should have been shipped out of your practice. And if you are in the vicinity of a thousand or more patients seen over the course of your career, which would mean 2000 or more case notes potentially shipped, it is literally impossible to believe that if you sent 2,000 case notes to the people other doctors in your community, you would not have conversations and or referrals. It's actually a statistical impossibility. So get out there, share the fact of who you are and what you do because I can guarantee you, the other doctors in your community and quite frankly probably you right now, have no idea how often you are co managing with each other. And that is the first step. Case notes rarely flood your Office with referrals by themselves, but they're the foundational layer. Let's talk about the next layer. The next layer are research updates. What's the point of research updates? To fill in the gaps between case notes. You might not send a case note to a doctor just because you're not co managing with them at that given time. That's not a big deal, but it's a crusher when you're talking about trying to build a referral relationship. You need to stay top of mind. So the research gives you the opportunity to deliver something of value to them each and every month, regardless of whether you've sent a case note or not. Absolutely critical piece of the puzzle. And research just tends to be the easiest medium or platform to be able to have your name in front of them in a professional manner. So that's why we provide personalized research briefs for our doctors each and every month. But I would really, really encourage you to do the same. And then the third are the meetings. The meetings, well, they build trust and rapport faster than anything else. There are plenty of doctors that I work with, including myself personally, that have gotten referrals from doctors based upon case notes and research alone. But when you can take meetings, it can speed up the process pretty dramatically. And the purpose of a meeting with another healthcare provider is not, I repeat, it is not to go there to sell your services. That's like totally weird. So what's not weird? What's not weird is to have a normal human conversation with another doctor in your community. What does that look like? That looks like asking direct and simple questions. So I'll strip away some of the fat here and get to the meat of it, which is, I like to ask a simple question every time I meet with a doctor. Hey, have you ever worked with or referred to a chiropractor before? Is there a more important question? By asking that question, you know where they stand. Have they had a negative past experience? Do they not know anything about what you do, which would not be surprising, especially if you haven't sent case notes or ever reached out to them before. That question opens the door. There's a lot we go into within the MD connection about how to answer that question, etc. But I want to just throw that out there to you today as an anchor to say, please start asking that question. Because when you ask that question, you get a really great understanding of who they are, what they do, and ultimately their friction points. And when you understand their friction points, whether it's lack of knowledge, whether it's previous experience, et cetera. Now you can directly tackle that. And you're not just pitching chiropractic blindly, which nobody cares about, but you're actually addressing their primary concerns because you actually ask the question. So asking the right questions is absolutely key. And that is a fast and furious three pillar explanation of how, knock on wood, I can stop seeing research like this saying, man, there's a lot of docs out there not really following the guidelines. What do the guidelines say? In many cases they should be going in to see you doctor the chiropractor listening. But in order to do that, we need to get out there, take action, get serious about it and ask good questions and utilize systems and processes that help us reach our full potential. So hopefully that's been a little bit inspiring. Hopefully you have some action steps there. If you have any questions, you can always reach out jeffevidencebasedchiropractor.com if you're interested in having help getting things done faster with all the templates, all the resources, all the tools, all the guides, then you can check out the MD connection. Now, before we wrap up, I want to say a few words about turncloud. Turncloud has stripped away anything that is not essential. They make everyday functions simpler and they've created an awesome intuitive application where nobody needs a user manual. So if you've been frustrated with your EHR, check out TurnCloud. Learn more at turncloud.com, have a conversation with their team. Have a fantastic holiday. Thank you so much for being a chiropractor and I will talk to you soon.

Thank you for joining us on this episode of the Evidence Based on Chiropractor. If you want to grow your practice, come back for next week's episode. If you want to grow faster, visit the evidencebasedchiropractor.com and join our MD Marketing membership today.