The Care Plan Paradox: Why Not Selling Makes You Sound Salesy | #549

Hello and welcome to The Evidence-Based Chiropractor. I am your host, Dr. Jeff Langmaid. On today's episode, we're going to talk all about care plans and, dare I say the word, sales. I have a pretty contrarian viewpoint on this, and I am pretty sure that you will get something out of today's episode that can make a really meaningful impact on your ability to communicate with patients and help more people in your community. Before we get started, few shoutouts to some of our partners. Leander Tables, you can save $750 off of their Series 950 using the code EBC2026 or connecting with their team, as well as Shockwave Centers of America. You can get $500 off one of their shockwave units and a free cart by letting them know you're a listener of the show. $1,250 in savings right there just for being a listener of this podcast. But on today's episode, we are talking all about care plans. And I'm gonna start with something I think every one of us has felt at some point in our practice. We go through an examination, we've got the history, maybe imaging, we got all of our movement assessment and functional assessment findings. And clinically, you know, with real confidence, we know the patient sitting in front of us needs a course of care, not one visit, not, well, let's do a few and see how you feel, a real care plan, a course of care, care. And when you get to the part where you have to say it out loud and lay out the plan and talk about the timeline and the cost, something in your chest tightens and it just doesn't feel right. And, you know, to me, this is a signal that you don't have a good process, not that you need to become a better salesperson. If recommending a care plan in your practice feels kind of pushy or salesy or beneath doing the clinical work, Often what you're probably gonna do is soften it. You're gonna hedge, you're gonna start under-recommending care. And that's really the paradox I wanna bring this whole episode around. The instinct that not selling is often the exact thing that makes you come across like you're selling hard, like you're selling a timeshare, and we'll get to why. But first, I really wanna highlight why a well-built care plan is not a sales tool. It's a clinical tool that happens have a financial component. And that's a fundamental shift. And I think once you see it that way, the discomfort around it starts to dissolve, not because you got better at selling, but because you stopped think of it as selling at all. And this has been something that has been a lifetime of learning for me. I don't talk about this a lot, but I'm gonna be talking about it more and more because I think it's so critical, not only for your patients to receive the best results, as we'll discuss, but also for the financial health of your practice. And not the other way around. This is about patient results first. Neuromusculoskeletal conditions, they respond to a care plan and a course of care, not a single intervention. There's literally nobody in any health corner of healthcare that meaningfully treats neuromusculoskeletal issues with kind of one visit and a handshake. Not PT, orthopedics certainly doesn't do it that way, post-surgical rehab, no way. The expectation is a structured multi-visit course of care. It's totally normal in every single profession. Yet in chiropractic, we act like it's getting a patient to commit to something that might be unethical. It's really, really wild. It's not. It's actually how tissue heals. It's how the nervous system adapts. And it's how you can help people go from acute pain to true functional ability and not having as many regressions along the way. And that's really just called in literature dose response. It's the idea the amount and frequency of care has a direct relationship to the outcome. So, I mean, you already know this intuitively watching your patients. You know, the ones that come in and really follow the course of care that you deliver, they do better than the ones who don't and disappear and, and come back 6 months, 1 year, 5 years later. It's not like a marketing observation. It's truly the clinical results. This has a direct impact on that in your practice. Now, the second variable we underweight, I think, is what's called adherence. Adherence is a clinical outcome. A patient who does not complete a care plan in your practice didn't get a different treatment. They got an incomplete one. So when we talk about care plans, what we're really talking about is the structure that makes adherence possible. The roadmap that lets your patients understand where they are, where they're going, and why the visits in the middle matter, even if they feel good. So the clinical case for a care plan is, in my view, airtight. The harder question is what a good care plan is actually built from. That's where I'm gonna dive into some specifics today. So if you take one structural idea, it's this, that a care plan is built on two things. Your exam findings and the patient's goals. That's it, 2 inputs. I'll say that one more time, your exam findings and the patient's goals. That's what a care plan should be built on. And I actually recommend you literally verbalize that to your patient. I'll go one step farther. I really like how my business partner Jason says, asking every patient upfront or letting them know, there are 3 reasons people come in to see me, temporary pain relief, to correct the cause, or for long-term performance and maintenance. Which of those is you? Just let the patient tell you what they're there for. Then you're able to do your examination, you know what their health goals are. Those are the foundational elements to it, building a care plan that's not generic, that's not salesy, that is literally for their benefit. So if you build a plan from exam findings alone, you'll get something clinically correct but generic. It's not gonna be for that patient. If you build from goals alone, just giving people what they ask for, Well, now you've abandoned your clinical judgment. So then you're like a vending machine, not a chiropractor, not a doctor, not a teacher, not a healer or an educator. So the patient's goals are what tell you the destination, but your exam findings should be informing the road and the path there. So your plan should live at the intersection of those two. Your findings define what's clinically appropriate. Their goals, their goals define what they're trying to achieve. And your job, I'm gonna say the art of this is to connect those two, really, really honestly. And when you frame out a care plan with the truth out loud to the patient, something can really shift. You're no longer pitching them a package. And this is often where I see carburetors like, you're either lauding the biggest PVA ever or on the other side, lauding the lowest PVA ever. And the truth is somewhere in between. Individuals, it takes time to overcome fear avoidance behavior. It takes time to change habits. If people are leaving your practice the first second they get out of pain, you're not making the maximum clinical impact. That's just a hard fact. You can't because you can't make the changes and habit changes, tissue reformation changes, and fear avoidance behavior changes necessary in 2 to 3 visits. That also doesn't mean you need to swing the pendulum to 27 years either. There is a middle ground here. So the 3-patient model, I think, helps this a lot. You know, every— almost every patient that comes into your practice is going to fall into one of those 3 categories, whether they're just looking for temporary pain relief. If that's their goal, they have a flare-up, they wanna feel better, and they're not interested in anything long-term, it's important to know that. The second type is gonna be most people. Well, I'm here to correct the problem. I'm here to get to the cause of what's going on. And the cause, I don't mean this in some sort of like old school salesy way, I mean it in terms of the cause is probably time, gravity, and bad habits over decades in many cases. So that doesn't solve itself with 1 or 2 visits. Yeah, the pain goes away quickly, But if they're there to reduce the risk and likelihood of pain coming back, and they're looking to change their life for the better, it's gonna take a little bit of work. And those are the patients often that have connected the dots. They don't just want the pain gone, they wanna understand why it keeps happening and fix it at the root. And then the third, the third is a little bit of future pacing, but you'll find them from now and every now and again. People that are there for long-term performance. Maybe they've often seen a chiropractor in the past and they moved to the area. Or, you know, they're just telling you, I'm sick of dealing with this. I really want to optimize and stay ahead of the problems. I got a little bit of an issue right now. It's really no big deal, but I'm here so that I can maintain optimal performance. It's gonna be a small portion of individuals, but if you're a sports chiropractor, you might see this more often than if you're a pain doctor, right? That's just what's gonna walk through your front door. And here's why this approach matters so much.

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The plan that's right for one of these patients is wrong for the other two, and forcing a patient into a plan that doesn't match their goals is where it starts to feel like sales. So, you know, this is a really critical part and also it's why, you know, not selling can come across as selling hard and that's really the big paradox here. When a care plan fails, often our instinct is to usually question the clinical reasoning. "Wow, was I too aggressive? Was the timeline too long?" In my experience, that's rarely the problem. It's a communication issue and specifically a discomfort around clear communication. That is really, you know, the big deal. So if I give you an analogy that clicked for me, it's a timeshare presentation, believe it or not. You know, what's the defining feature of a timeshare pitch? It's the guy who keeps telling you he's not selling you anything. Yeah, there's no pressure here. I'm not gonna ask you to buy anything today. I just wanna show you around. You know, there's relentless friendliness and the entire time, every person in the room knows exactly what's happening and it feels weird, slimy, and not good because of the gap of what's being said and obviously what's going on. The harder he insists that he's not selling either to himself or herself, or to the person who's there, the more it feels that way. And when you, when a doctor or chiropractor gets nervous about a care plan and tries to soften it, when you're hedging, when you're downplaying the recommendation, when you're saying, "Oh, no pressure," when you get vague about the cost or, you know, say, "We'll see how it goes," the patient's gut reads at the same exact time and it comes off exactly like a timeshare presentation. The discomfort is the tell. Your attempt to not feel salesy is what makes it seem salesy. So what's the antidote to this? It's not to sell softer, it's just to be clear and direct. The least salesy thing you can do is look the patient in the eye and let them know, "I can help you. Here's what I found. Here's how long it's gonna take. Here's what I recommend and here's how much it costs. How would you like to take care of that today?" There's no vagueness, it's really just clarity. Because, and this is what's so critical, those 5 items. So if clarity is the goal, what does the patient need to have clarity on? This is absolutely critical. It's very difficult for a patient to be able to say yes or no or understand what they're actually doing if they don't understand the answers to 5 questions they have in their head, and we'll walk through one of them. The first one, and these should literally be verbalized, the first one is, "Can you help me?" Before anything else, the patient, your patient should be hearing directly that you believe you can help them or honest guidance towards somebody that can if you can't. So letting people know, hey, we can help you. The second one, what did you find? This is your exam findings, you know, translated in English, right? So not jargon, but a plain English explanation of what you found. Here's what we found, A, B, C. Third, how long will it take? This is the timeline, the phases and the checkpoints. And this really depends upon what of those 3 patients is in front of you. The relief person is looking for how short it's gonna be. The correction person's expecting a little longer. Performance knows it's ongoing. So just be honest here. Here's how long it's gonna take. Fourth, what do I recommend? This is the actual plan. I expect it to take this long. Now here's the actual plan we put together for you. And this is just really, really critical. It's just about being plain and simple. Your clinical recommendation stated plainly. And then fifth, how much will it cost? This is where you're just gonna present whatever your payment options are. I recommend having 3 payment options. Here's our pay in full option, here's our payment plan, or here's the pay as it goes. And you obviously incentivize what you want based upon discounts or however you wanna do it in your practice. And that's really it. Can you help me? What did you find? How long will it take? What do you recommend? And how much will it cost? When you build your report of findings and care plan to, to help people understand these in very plain English language, It's great for them and it's really nice for your business as well. If we come back to that fifth one, how much will it cost? This is where docs really can go off the rails. And it's really easy if you feel uncomfortable saying the number, it's not, the problem happened 10 minutes ago. I'll say that one more time. If you're feeling uncomfortable with the presentation of the number of the care plan, you didn't go through the steps before it because the cost should just be a, nobody's expecting to get it for free. So the cost is a natural extension of what you highlighted. We can help you. Here's what we found. Here's how long it's gonna take. Here's my recommendation. And it's really important to understand which of those 3 types of people there are, which they are, and additionally, what's the life impact or life effect? You've probably heard me say time and gravity are undefeated. And people come in not never because of pain. People live with pain for days, weeks, months, and years. We all know it. They're coming in because there's a life effect of that pain. So you wanna make sure you're tying the answers to those 5 questions directly to what they've told you the problem is. And the problem is not my back hurts. The problem is my back hurts and I can't go golfing and I've been waiting my entire life to retire and go golfing. That's the thing. I call that turning over the stone. If they tell you there's pain, that's the stone. Everybody can see that, that's easy. Your job is to be a clinician, to be a doctor, to turn over the stone. Well, how is this impacting you? What really brought you here today? And then just being honest and direct about what it will take to move from there. So, you know, all of this comes to a head With— if you've been on my email list, you probably see me talking about CarePlan Pro. And you know, it's not an EHR, it's not a billing software, it's not supposed to replace your EHR. It fills this specific gap, turning care plans that you present into something patients can understand and say yes to right there with the payment piece handled cleanly within the app as well. So it's a really, really key part is not only having the training and the knowledge, but also having the software necessary ultimately to help you get where you need to be. So if we bring this back to where we started, 2 inputs, 3 patient types, you know, the timeshare paradox, you know, 5 questions, all of this comes down to really adherence. And doctors who get strong completion rates, they do a few things really consistently. They connect care to the patient's life impact over and over and over again, because that's really why the person's there. That's not weird. That's being a good listener and letting people know that you're being specific to them. And they use a re-exam to make the progress visible over time. Because progress is the biggest driver of staying the course. Whether this is with your movement assessments, pain decreases happen early. But the movement changes happen— excuse me, the movement assessment changes, the functional outcomes happen over time. So if we pull all of this together, care plan is really built on two things: exam findings and patient goals. And it has to match one of those 3 patient types that's in front of you. You want relief, to correct the cause, or long-term performance. And it fails far more often at the point of communication than at the point of clinical reasoning. And kind of the cruelest irony in all of this is that trying hard not to sell is exactly what often makes things come across very, very, very salesy. So we have put out there Care Plan Pro and a playbook. We have it super discounted to get started. It's a 4 4-week course on exactly what I just described. 4 modules that walk through every single aspect of this. Me on video breaking it down. You get frameworks, worksheets, tools that you can download and implement. And then you also receive CarePlan Pro, our brand new software. This thing is transformational. I'm super proud of it. I'm not gonna spend too much time talking about the nitty-gritty of CarePlan Pro, but I'll drop a link down below. You can check it out. CarePlan Pro basically enables you to build templates. We have 70+ evidence-based templates for all different types of conditions and modalities already built out. You get to customize them or build your own. You save it, you enter a patient in about 30 seconds, and then you can apply a template to that individual based on what's going on with them. And you have a beautiful modern presentation right there that you can use on your iPhone, on your tablet, on your desktop, whatever you want to present on, that literally walks you through all— answering all 5 of these questions for that patient with specificity. And then you can actually take payment right there. We have deep integration with Stripe, or if you wanna keep your existing payment provider, go ahead, go for it. But ultimately CarePlan Pro makes it super easy with Playbook is the coaching component of this. We also built out Alex, our AI sales coach, where you can call. I've already seen a bunch of docs coming in and it's awesome. Alex can literally roleplay with you, so it doesn't have to be super weird with you trying to roleplay with your associates or your partner or our coach, which sometimes just feels really weird. It's like the first thing everybody says, ah, it's gonna feel weird, just move through it. Why not just make it not feel weird? So Alex is there, you give a call, run reps on different types of patients, and Alex will critique you. Did you spend enough time on the life effect? Did you skip steps in that presentation? You can do it privately and it is awesome. So I'm gonna drop a link to Care Plan Pro Playbook. It is a limited time opportunity going on right now with our launch for the first 100 docs. Those spots are filling up quick. Care Plan Pro, the software, also you'll be able to get access to that 60 days for free with Playbook, so check that out. You have questions, you know how to reach out to me. But I hope this was really valuable. I'm gonna be exploring some more of this on and off between some of the research, 'cause this is a really, really important topic. Knowing the research is one thing, being able to put it into action for the benefit of people in your community, and ultimately prescribing care and helping people get to yes, not in a salesy way, but everything we described today, being direct, being clear, and helping people get the care they need without under-recommending care, which is bad for you and bad for them. So I hope this was very valuable for you. I love your feedback. Always shoot me a message, jeff@theevidencebasedchiropractor.com. Whether this is your first episode or nearly 550th episode listening, thank you so much. If you have not left a rating or review, please scroll on down and do so. That helps more and more docs find out about this podcast. Have a fantastic week in practice, and I will talk to you soon.

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