#59 - Supercharge your Clinical Skillset, Part 1

Hi guys! Welcome to a new episode of The Factor Podcast. I'm your host, Jessica Riddle. If this is your first time tuning in, welcome and thanks for listening. In today's episode, we kick off a new training titled Supercharge Your Clinical Skillset with Dr. Benjamin Fergus. Dr. Benjamin Fergus is the owner of Cornerstone Health, a clinic in the Chicago area specializing in helping individuals overcome chronic pain and regain their quality of life. Through their unique approach called the GRIP approach, Dr. Fergus and his team have achieved a remarkable 99% success rate in treating chronic pain. They focus on helping their clients achieve their goals through their foundational fitness program, which helps them graduate into a state of clinical fitness. In this 2-part training, Dr. Fergus shares his insights on hiring the right team members, building a collaborative and effective healthcare practice, And achieving clinical and financial success. Get ready to learn how to differentiate yourself in the industry, set and achieve physical goals with your patients, and discover the power of a team-centered approach. So grab your notebooks because this episode is packed with valuable tips and practical advice. Let's get started.

Good afternoon, everybody. Thank you for joining. And Jessica, thank you for inviting me to present to your audience. Let's jump right in to this concept of supercharging your skillset. My background is a clinic owner of Cornerstone Health in the Evanston or Chicago area. And our practice specializes in helping individuals overcome chronic pain and get back to doing things that are really important to them again. The way we manage our practice is with the GRIP approach, G-R-I-P approach. That's a seminar and a system that we've developed to help us have consistent success with our clientele. And a big part of our program is helping our clients graduate into clinical fitness via our foundational fitness program. Why you are here. I think we can agree, we all want to help a lot of people and make an impact in our community. Our community might be as focused as 1 to 2 private clients you work with, or as broad as you can scale. Additionally, we all want to have a healthy profit margin for our time and work investment. Businesses need profit. Employees need the business to profit. So I hope that today you can take what you learn To either launch your practice or organize your existing practice for greater success, supercharge your own skills with a clear framework for consistent results, and make your skills scalable so that a team can help you achieve your clinical mission. We can do all of this with GRIP approach. Success is determined from the start. Everything hinges on the initial patient encounter. This success is determined primarily by the language you choose when you communicate with your patient. The questions you ask your patient are teaching them what you think is important, and they're going to attach a value or concern to it. So we need to ask questions that clearly identify a successful outcome. I'm going to challenge you to change your mindset. And to change your language. I'm going to challenge you to ditch pain interviewing. And before we get up in arms about that, please note our clinic has a 99% success rate helping people overcome chronic pain. Yet we rarely talk about pain in our clinic. See, patients often feel under attack by pain. Pain is bad and things that make me feel pain are bad. So the patient goal might be to not feel pain. However, focusing patient interviewing on their subjective pain experience places too high of a value on it. This can lead to catastrophizing and it can make the outcome goals focused on something that is fickle and hard to measure. So focusing on pain can limit success from the start. Success is determined from the start. So before we even get into a physical examination in my clinic, we do some goal setting with the patient. These goals need to be objective and physical goals. A really good intake form is the Patient Specific Functional Scale or PSFS. That should be available online that you can download. It's a standardized initial visit interviewing form. And then our interview with the patient needs to be a goal-oriented interviewing process, asking questions like, what tasks or activities are you finding challenging to perform? That's a highly valuable question, yet it doesn't ask them about pain. It asks them about Function. So try not to set your goals based on the highly variable and flammable subjective pain experience. We're going to go through a flow of macro, then micro, then action. First, you need to identify the macro goals or limitations. Next, identify the micro barriers that keep the patient from the macro goals. Finally, focus your action on overcoming the micro barriers in order to achieve the macro goals. Let's see that in action. First, we need to ask some questions that lead to success. Here are a few that I love to ask my patients. Let's think about the big picture here. What are some things that you would like to envision yourself doing That seem out of reach today? Now, with this question, that might be a good thing to ask a reexam or at the end of care. But I found that by asking a question that way, before I even do an examination, we start to flip that switch in the patient's mind that they want to envision something better for themselves. They want to envision a goal or see themselves doing something that brings them joy. And then we sort of position ourselves as a guide that helps them achieve those big visions. Next, what would you do today if you didn't have this problem? Are there some specific movements that feel challenging or limited today? Can you demonstrate? None of these questions ask about that pain factor. However, it's okay if your patient tells you about pain. We're going to keep Reducing the value of the pain experience in a safe way by asking more about limitations and goals and not focusing on that subjective experience of the pain. This is your macro goal setting. This is the recovery roadmap, and I go through this form before I begin my physical exam, and we're going to focus on the bottom box on the right. that I filled out for my patient Tom, who I saw a few weeks ago. When I asked Tom his questions about what he'd like to be doing or what he feels limited for, he has some very clear answers. He wants to celebrate his 80th birthday by hiking with his kids at Yellowstone. Great goal. I love that functional goal for Tom. Also, he loves strength training, and recently he sort of hates strength training. It's not going well for him. So he'd love to be able to strength train 4 days a week. Additionally, a few times a year, he loves to take his kids and go on a golf trip. He'd like to golf for a 3-day weekend, but the past few trips he's been sitting on the sidelines. So our big macro goals are a 6-hour hike, strength training 4 or 5 times a week, and a 3-day golf trip. Then we're going to break that down into some steps along the way that help us get Tom from where he is today to those ultimate goals. If we pop on up to the top box, we're gonna look at our early indicators of success. So this is through our first phase of treatment. We'd like Tom to be working towards his ultimate goals. So an earlier sign of success would be walking half a mile a day, 15 minutes of bodyweight exercise every day, and being able to rotate his spine and his hips to about 30 degrees. All of these small goals will let us know that we're well on our way to the ultimate goals. At a following re-exam, we set slightly bigger goals. Walk 2 miles a day for 3 days a week and start to do some bigger functional strength movements like a Bulgarian split squat, kettlebell press, or TRX row. And let's knock off another element of golfing. I'd like him to be able to rotate his spine 45 degrees and begin swinging his irons. This form will allow you to sit with your client and determine right from the start what successful outcomes would be for you and for the client. And it's not focused on pain. It's all focused on those big goals. Make sure that you and your patient are now viewing successful outcomes the same way. You need to agree on success before you start.

First, acknowledge.

Tom, these are some great goals. I know it can be frustrating to have a clear idea of what you want to do, but feel like your body's letting you down. Next, inspire. We've seen limitations like this before. In fact, we've helped a lot of patients overcome their limitations and get back to their goals. Our exam is set up in a way that will make sure we can help you as well. Finally, agree on success. So if we're able to help you get back to hiking, golfing, et cetera, would you feel like that would be a successful outcome? Would you feel like this made a good impact on your life and your health? So we need to agree on success from the start. The real power of physical goal setting is as follows. The patient leaves that goal setting with a clear vision for success. You haven't needed to sell or describe any of your services. You've positioned yourself to be able to use your entire skillset to help the patient get to their physical goals. You aren't hamstrung by fickle subjective goals, and you can objectively measure success each visit without having to ask the patient how they're feeling. In fact, I love to ask, How are you moving? Or what have you been able to accomplish since our last session? Here's a big one. Any skilled provider on your team can step in and help them accomplish their goals. Next, we move into the micro. Macro first, then micro. Micro is the rest of our physical exam. In our office, we need to do some standard exam tests like vitals, neurotesting, and orthotesting Although we do that ortho testing, trying to avoid that pain catastrophizing, not asking too many detailed questions about pain, rather test the movements, feel the function, note the change. Then we do our focused and functional evaluation. This is our grip functional range of motion evaluation. It's the real power of our success. Next, as needed, as indicated, we do some special tests like neurodynamics, labs, images, or Nerve conduction studies, EKG, you get the picture, whatever's needed for the unique case. But everything kind of hinges back on that focused and functional evaluation. That's the one that helps us connect our patients to their successful outcomes.

If you're listening to this podcast and you've yet to attend a Factor Rehab live course, I have a special offer just for you. See, I realize that sometimes you need to kick the tires a bit. to learn more about a course before you register, especially one that offers a certification track. So, I've developed a special offer just for those of you who are interested in learning what this FACTOR thing is all about. See, we've put together a free 1-hour webinar to introduce the concept of having a systematic approach to rehab. In this 1-hour online course, our Director of Education, Dr. Todd Riddle, will show you how implementing a system for patient treatment can improve patient outcomes, streamline your operations, grow your profitability, and help you to build a practice that you absolutely love. You'll also hear from Dr. Riddle's personal experience in using the FACTOR Rehab System, both with elite athletes as well as the everyday patient just looking to move and feel their best. It's a great first step to learn more about FACTOR certification and how FACTOR can impact your patient care. And to sweeten the deal, we're offering CE credit for completing this online training absolutely free. Yes, you heard that correctly, free CE. So CE credit is available in a number of US states for chiropractors, as well as for massage therapists, athletic trainers, and physical therapists. To learn more and get your free CE while learning more about how FACTOR can impact your patient care, visit the free FACTOR webinar link in our show notes. Now, back to the show.

A simplified version of that. First, rule out anything that poses a risk. Next, note what you need to for your standard documentation. And then finally, get to the real stuff. Identify what individual limitations are getting in the way of their big goals. Example, loss of left hip internal rotation and thoracic external rotation are limiting the ability to play golf. We've connected the micro loss of hip rotation to the macro ability to play golf. With micro plus macro, you have now agreed on big physical goals, macro, positioned yourself to help them accomplish those goals using your whole skillset, and found the individual limitations that need to be overcome, micro. If you do this, and I'm going to challenge you to start today, If you do this with every single new exam and re-exam, you will have an office filled with patients who are a perfect fit for what you do and are fired up to get better and accomplish more. Next, action. Macro, micro, action. Each session builds towards the ultimate physical goals. Success is not judged by the immediate treatment effects, which can be transient. Success is judged by progress towards the ultimate goals. Whatever clinical tools you utilize, always circle back to the big goals. Example, we are using this extra thorax exercise 4 times a day. That's the dose so that your spine can rotate 45 degrees. That is going to make your 3-day golf trip so much better. Again, we're using this exercise So that you can overcome the limitation. That's micro. So that you can get back to your 3-day golf trip. That's the macro. That's the success with this case. Even, we've heard the saying, only tool's a hammer, everything's a nail. But even if your only tool is a hammer, it can still be really awesome at driving in the right nails. We need to make sure we're working on the right things that helps our client move towards success. So tie your skillset to the biggest problem to accomplish the patient goals. And if your skillset is falling short, if your skillset is not accomplishing these goals, then you start searching for what you need to add to have a better success rate with that particular problem. Now we've refined our skillset and made it in a way we can put it in your hands with our Virtual Grip Program. Let's take a little look at GRIP approach. GRIP is an acronym. It stands for Global Rehabilitation and Injury Prevention. It's an objective assessment that also classifies the findings and is connected to a treatment arm so that it's very actionable. We apply this system with patients as well as athletes at every level. And I've been fortunate enough to teach this to a lot of providers who are currently translated into 7 languages. Too often clinicians and trainers feel like they're missing something due to some inconsistent results with clients because they might be overwhelmed by an abundance of tools but not have an excellent framework to deploy them. So we've developed that 3-part framework that empowers you to know exactly what to do to get great results. So with GRIP, we want you to have clarity, consistent results, and then build your reputation to become the expert. Essentially, the way this works in a flow is our FRAM assessment, functional range of motion. Then we move towards corrective exercises and/or soft tissue treatment, including joint manipulation. And then we graduate into strength training. Let's look at that flow in a different way. Following our macro goal setting, we start by identifying the micro limitations using a functional range of motion screen. This is essentially a range of motion testing, but it's not passive. And when we do the active portion, we have a clear eye for compensations in a few key zones of stability. So we're essentially asking the nervous system to move the anatomy at a single joint and a single plane of motion at a time. Then we rate that for its quantity. And its quality, identifying the biggest limitations. We then operate on an assumption that each movement that's at deficit is primarily a motor control deficit. And we confirm that by using a global reset strategy. This is a neuro-based exercise. With a minute or 2 minutes of global reset, we can recheck the efferent And if we see a substantial change, we know that this is motor control and it's not tissue and it's not joint. And we can progress with exercise until we follow to that point 3 on the bottom, global performance strategies or gym exercises. However, a lot of cases do need the structural interface to be addressed. And we've mapped that out with fascial manipulation and joint manipulation using our targeted structural interventions. So this is our simple 3-part framework to help Tom go from where he's at today to that golf trip and hiking trip. Now, there's a resource that's available to you that will, will help as we go through the next section of this presentation. If you type in, in a new window, gripapproach.com, you'll see this nice screen. And you have 2 options on the home screen here. One, you can enroll in this free class. When you do that, you'll have immediate access to a 5-hour seminar that talks in more detail about what we do and is also going to give you some great exercises and tests to use day one. Or you can go on over to enroll in the full coursework, and that will give you access to our complete library. Once registered, you get access to your technique library like this. This is the Foundations of Grip This is the free one, but then the rest of the body is segmented to lower extremity, upper extremity, or spine. And when we click into those particular libraries, every technique is divided by the joint, in this case hip, and the plane of motion, in this case hip adduction or medial motion. You'll see our clear test that every examining provider can use. Then you'll see how we address that with a corrective exercise and with a specific tissue technique. So this is meant to be a map that once the clinician says the problem is golf, he wants to get back to golf. The micro limitation is hip adduction in this case. Then you can take that case and hand it over to the treating provider. And you can, if you're the treating provider, You can access your entire skill set and say, I know he wants to golf. I know the biggest limitation is hip adduction. And here are the 5, 10, 15 things that I know I'm great at using to recover hip adduction. You can deploy that entire skill set, retest, and get Tom onto his golf trip. In each video, you'll also see a little description below with more information. And you can slide through multiple joints. So this is the online virtual GRIP. I encourage you to get started today. It's free to do so to begin with. Next, we have a system. Now we need to systematize your success. With GRIP, we help you to systematize your clinical success so that you win every case. You can do that online and use your current skillset and then meet with us in person to tune it up some. Let's talk about scaling your success. Now, the basic economic overview of practicing in this rehab goal-oriented way is essentially your patient will be with you for a minimum of 15 minutes and a maximum of 60 minutes. My exams are typically 45 to 60 minutes, whatever it takes to get a really clear picture. And my average treatment session may be 30 minutes. So that means with this model, and you can note this down, a single provider is limited by roughly 6 exams and 48 treatments in a completely booked 30-hour week. So that number, the 48 treatments, for some of you, that might seem like a good goal, an achievable goal to work for in your first period of practice. And some of you may already see a really high volume, a much higher volume than that. And think, well, how do I transition to these new techniques if I'm limited to 48 treatments in a week in a 30-hour week? So that might be the dilemma that comes up. But the overall basic economic overview, you can plug in your treatment costs with these numbers and understand how the system would work for you in your area. But ultimately, we need to scale what makes you great to be most effective. We need to provide our patient with a clinician, a rehab specialist, a soft tissue specialist, and an exercise specialist. Many of us begin by building a skill tower within ourselves. This is how I began, and many of you do as well. It's adding one level of skill onto the next. Until you are a very effective, very skilled tower, but you're still just one piece. Some people build a team that can work together for a common goal. In this way, one individual does not have to have all of the skills as long as every skilled person on the team communicates really clearly. I started as a skills tower, but I am convinced in the power of a successful team. Teamwork makes the dream work. This is a book on the right that I recommend to all of you that are building a team. It's The Power of a Positive Team. Great quotes, great mindset. You are contagious. The energy you put into your team and culture determines the quality of it. So as you may scale and build a team, you have to have a clear mission for your practice and some clear energy that you put into growing the team that you want to have. Bottom line, teams can have a bigger impact on their community and mission than a single skilled provider. So if you want to help more people, you need to scale your success by building a team that's fired up and communicates well. I built the Virtual Grip program so that providers could build their skillset, but also easily scale their impact by training their team with that program. If you as a clinician can nail the exam, identifying the macro and micro movements, then Grip can step in and train your clinical staff how to successfully achieve exceptional results. This does put some issue to an extent for the examining provider in that your exam charts need to be communicated so that anybody can pick them up. You need to write them in a way that you clearly identify the big physical goals and you've highlighted the micro barriers to those big goals.

That's it for today's episode. Be sure to tune in for episode 60, where we wrap up part 2 of this training. Dr. Fergus will discuss how he asks questions about the tasks and activities that patients find challenging in order to set objective and physical goals, rather than basing goals solely on pain. He will also discuss the importance of setting macro goals and then identifying micro barriers that prevent patients from achieving those goals, and he'll walk us through his process for creating a recovery roadmap, which breaks down the goals and steps needed to achieve them. You won't want to miss it. Episode 60 drops in 2 weeks. You can subscribe to The Factor Podcast on Apple, Spotify, iHeartRadio, or the podcast app that works best for you. Give us a 5-star rating to help us grow the show. Every little bit helps. And last but certainly not least, be sure to visit our show notes for special promotions from our sponsors, a link to download the PDF of today's full presentation, And view the recorded replay of the full webinar. You'll also always find a special Q&A link where you can submit any questions that you have for our presenter. We'll see you next time. Hey guys, if you like what you heard today, I encourage you to visit our website at factor-store.com. That's spelled F-A-K-T-R-store.com to find out more information about all that we have to offer. We have a variety of online offerings as well as our hands-on Factor Rehab System course scheduled in cities around the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.